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A Cost-Effectiveness Model for Comparing Multiple Micronutrient Supplements to Iron and Folic Acid Supplements During Pregnancy: Applications in Pakistan, Bangladesh, and India

18 Pages Posted: 8 Aug 2018

See all articles by Bahman Kashi

Bahman Kashi

Queen's University

Caroline Godin

Queen's University

Zuzanna Kurzawa

University of British Columbia (UBC)

Allison Verney

Nutrition International

Jennifer Busch-Hallen

Nutrition International

Luz Maria De-Regil

Nutrition International

More...

Abstract

Background - Recent evidence has encouraged low- and middle- income countries to consider transitioning from long-standing iron and folic acid supplementation (IFAS) to multiple micronutrient supplementation (MMS) during pregnancy. However, global guidance is limited. To help countries' decision-making, a cost-effectiveness model to compare the supplementation modalities was developed, and applied to: Pakistan, Bangladesh, and India.
Methods - The effectiveness of IFAS relative to MMS during pregnancy was compared using eight health outcomes reported in the literature: maternal anaemia, preterm delivery, small-for-gestational-age newborns, low birth weight, stillbirths, and maternal, neonatal, and infant mortality. Outcomes were aggregated using disability-adjusted life years (DALYs) to derive an overall effectiveness of IFAS and MMS. Costs included the supplements and their distribution through antenatal care. The incremental cost-effective ratio (ICER) for transitioning from IFAS to MMS was calculated for each country, and Monte Carlo simulations were applied to generate a measure of certainty around the results.  
Findings - In Pakistan, Bangladesh, and India, MMS would avert 11,749, 12,462 and 9,332 more DALYs than IFAS per 100,000 pregnancies, respectively (80.0%, 91.0%, 87.0% certainty). The ICER of transitioning from IFAS to MMS was 15.53, 13.94, and 19.55 USD (2016) per DALY averted, respectively.
Interpretation - As per World Health Organization criteria, transitioning from IFAS to MMS is cost-effective. While the effectiveness of MMS is sensitive to the prevalence of various health outcomes, with high confidence 80.0%-91.0% MMS averts more DALYs than IFAS and should re-enter public health discussion in Pakistan, Bangladesh, and India.
Funding Information: Nutrition International with a grant from Global Affairs Canada and World Vision Canada.
Competing Interest Declaration: All authors declare they have no conflicts of interest.

Suggested Citation

Kashi, Bahman and Godin, Caroline and Kurzawa, Zuzanna and Verney, Allison and Busch-Hallen, Jennifer and De-Regil, Luz Maria, A Cost-Effectiveness Model for Comparing Multiple Micronutrient Supplements to Iron and Folic Acid Supplements During Pregnancy: Applications in Pakistan, Bangladesh, and India (July 23, 2018). Available at SSRN: https://ssrn.com/abstract=3219542 or http://dx.doi.org/10.2139/ssrn.3219542

Bahman Kashi (Contact Author)

Queen's University ( email )

Kingston, Ontario K7L 3N6
Canada

Caroline Godin

Queen's University ( email )

Kingston, Ontario K7L 3N6
Canada

Zuzanna Kurzawa

University of British Columbia (UBC) ( email )

2329 West Mall
Vancouver, British Columbia BC V6T 1Z4
Canada

Allison Verney

Nutrition International ( email )

Ottawa, Ontario
Canada

Jennifer Busch-Hallen

Nutrition International ( email )

Ottawa, Ontario
Canada

Luz Maria De-Regil

Nutrition International ( email )

Ottawa, Ontario
Canada

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