Replacing iron‐folic acid with multiple micronutrient supplements among pregnant women in Bangladesh and Burkina Faso: costs, impacts, and cost‐effectiveness
Open Access
- 27 May 2019
- journal article
- research article
- Published by Wiley in Annals of the New York Academy of Sciences
- Vol. 1444 (1), 35-51
- https://doi.org/10.1111/nyas.14132
Abstract
Consumption of multiple micronutrient supplements (MMS) during pregnancy offers additional benefits compared with iron‐folic acid (IFA) supplementation, but the tablets are more expensive. We estimated the effects, costs, and cost‐effectiveness of hypothetically replacing IFA supplements with MMS for 1 year in Bangladesh and Burkina Faso. Using baseline demographic characteristics from LiST and effect sizes from a meta‐analysis, we estimated the marginal effects of replacing IFA with MMS on mortality, adverse birth outcomes, and disability‐adjusted life years (DALYs) averted. We calculated the marginal tablet costs of completely replacing MMS with IFA (assuming 180 tablets per covered pregnancy). Replacing IFA with MMS could avert over 15,000 deaths and 30,000 cases of preterm birth annually in Bangladesh and over 5000 deaths and 5000 cases of preterm birth in Burkina Faso, assuming 100% coverage and adherence. We estimated the cost per death averted to be US$175–185 in Bangladesh and $112–125 in Burkina Faso. Cost per DALY averted ranged from $3 to $15, depending on the country and consideration of subgroup effects. Our estimates suggest that this policy change would cost‐effectively save lives and reduce life‐long disabilities. Improvements in program delivery and supplement adherence would be expected to improve the cost‐effectiveness of replacing IFA with MMS.Keywords
Funding Information
- Bill and Melinda Gates Foundation
This publication has 17 references indexed in Scilit:
- Verbal Autopsy of Stillbirths and Neonatal Deaths in a Rural Area of Burkina FasoOpen Journal of Pediatrics, 2015
- Motor Severity in Children With Cerebral Palsy Studied in a High-Resource and Low-Resource CountryPEDIATRICS, 2014
- Preterm-associated visual impairment and estimates of retinopathy of prematurity at regional and global levels for 2010Pediatric Research, 2013
- Economic evaluation of neonatal care packages in a cluster-randomized controlled trial in Sylhet, BangladeshBulletin of the World Health Organization, 2013
- National and regional estimates of term and preterm babies born small for gestational age in 138 low-income and middle-income countries in 2010The Lancet. Global Health, 2013
- Overview of the Lives Saved Tool (LiST)BMC Public Health, 2013
- Improved neonatal survival through economically sustainable reorganization of a neonatal care unit in a developing country: 7-year experience in the Centre Medical Saint Camille (CMSC) of Ouagadougou, Burkina FasoJournal of Medicine and the Person, 2012
- Costs and Cost-Effectiveness of Training Traditional Birth Attendants to Reduce Neonatal Mortality in the Lufwanyama Neonatal Survival Study (LUNESP)PLOS ONE, 2012
- Malnutrition and health in developing countriesCMAJ : Canadian Medical Association Journal, 2005
- Calculating and presenting disability adjusted life years (DALYs) in cost-effectiveness analysisHealth Policy and Planning, 2001