Cost-effectiveness of invitation to food supplementation early in pregnancy combined with multiple micronutrients on infant survival: analysis of data from MINIMat randomized trial, Bangladesh

BMC Pregnancy and Childbirth

Lars Lindholm¹  Peter Kim Streatfield³  Shakil Ahmed⁴  Lars Åke Persson²  Rubina Shaheen² 

[1] Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden;International Maternal and Child Health, Department of Women’s and Children’s Health, Akademiska sjukhuset, Uppsala University, Uppsala SE 751 85, Sweden;icddr,b: International Centre for Diarrheal Disease Research, Bangladesh, 68 Shaheed Tajuddin Ahmed Sarani Mohakhali, Dhaka 1212, Bangladesh;Nossal Institute of Global Health, The University of Melbourne, Melbourne, Australia

关键词: Bangladesh;    Infant mortality;    Micronutrient supplementation;    Prenatal food supplementation;    Cost-effectiveness;   

Others  :  1206396
DOI  :  10.1186/s12884-015-0551-y

 received in 2014-10-29, accepted in 2015-05-08,  发布年份 2015

【 摘 要 】

Background

Absence of cost-effectiveness (CE) analyses limits the relevance of large-scale nutrition interventions in low-income countries. We analyzed if the effect of invitation to food supplementation early in pregnancy combined with multiple micronutrient supplements (MMS) on infant survival represented value for money compared to invitation to food supplementation at usual time in pregnancy combined with iron-folic acid.

Methods

Outcome data, infant mortality (IM) rates, came from MINIMat trial (Maternal and Infant Nutrition Interventions, Matlab, ISRCTN16581394). In MINIMat, women were randomized to early (E around 9 weeks of pregnancy) or usual invitation (U around 20 weeks) to food supplementation and daily doses of 30 mg, or 60 mg iron with 400 μgm of folic acid, or MMS with 15 micronutrients including 30 mg iron and 400 μgm of folic acid. In MINIMat, EMMS significantly reduced IM compared to UFe60F (U plus 60 mg iron 400 μgm Folic acid). We present incremental CE ratios for incrementing UFe60F to EMMS. Costing data came mainly from a published study.

Results

By incrementing UFe60F to EMMS, one extra IM could be averted at a cost of US$907 and US$797 for NGO run and government run CNCs, respectively, and at US$1024 for a hypothetical scenario of highest cost. These comparisons generated one extra life year (LY) saved at US$30, US$27, and US$34, respectively.

Conclusions

Incrementing UFe60F to EMMS in pregnancy seems worthwhile from health economic and public health standpoints.

Trial registration

Maternal and Infant Nutrition Interventions, Matlab; ISRCTN16581394; Date of registration: Feb 16, 2009.

【 授权许可】

   
2015 Shaheen et al.; licensee BioMed Central.

【 参考文献 】

• [1]World Bank. Staff appraisal report: Bangladesh integrated nutrition project. Population and human resources division. Washington, D.C.: World Bank; 1995. Online at: http://data.worldbank.org/country/bangladesh Accessed April 16, 2013.
• [2]Project monitoring assessment report: Bangladesh integrated nutrition project. Washington, D.C., World Bank; 2005.
• [3]Shaheen R, de Francisco A, El Arifeen S, Ekstrom E, Persson LÅ. Effect of prenatal food supplementation on birth weight: an observational study from Bangladesh. Am J Clin Nutr. 2006; 83(6):1355-61.
• [4]Merialdi M, Carroli G, Villar J, Abalos E, Gülmezoglu AM, Kulier R et al.. Nutritional interventions during pregnancy for the prevention or treatment of impaired fetal growth: an overview of randomized controlled trials. J Nutr. 2003; 133:1626S-31.
• [5]de Onis M, Villar J, Gulmezoglu M. Nutritional interventions to prevent intrauterine growth retardation: evidence from randomized controlled trials. Eur J Clin Nutr. 1998; 52 Suppl 1:S83-93.
• [6]Osrin D, Costello A. Maternal nutrition and fetal growth: practical issues in international health. Semin Neonatol. 2000; 5:209-19.
• [7]Composition of multiple micronutrient supplements to be used in pilot programme among pregnant women in developing countries. UNICEF, New York: NY; 1999.
• [8]Christian P, West KP, Khatry SK, Leclerq SC, Pradhan EK, Katz J et al.. Effects of maternal micronutrient supplementation on fetal loss and infant mortality: a cluster-randomized trial in Nepal. Am J Clin Nutr. 2003; 78:1194-202.
• [9]Roberfroid D, Huybregts L, Lanou H, Henry MC, Meda N, Menten J et al.. Effects of maternal multiple micronutrient supplementation on fetal growth: a double-blind randomized controlled trial in rural Burkina Faso. Am J Clin Nutr. 2008; 88(5):1330-40.
• [10]Kaestel P, Michaelsen KF, Aaby P, Friis H. Effects of prenatal multimicronutrient supplements on birth weight and perinatal mortality: a randomised, controlled trial in Guinea-Bissau. Eur J Clin Nutr. 2005; 59(9):1081-9.
• [11]Shankar AH, Jahari AB, Sebayang SK, Aditiawarman, Apriatni M et al.. Effect of maternal multiple micronutrient supplementation on fetal loss and infant death in Indonesia: a double-blind cluster-randomised trial. Lancet. 2008; 371(9608):215-27.
• [12]Ronsmans C, Fisher DJ, Osmond C, Margetts BM, Fall CH. Multiple micronutrient supplementation during pregnancy in low-income countries: a meta-analysis of effects on stillbirths and on early and late neonatal mortality. Food Nutr Bull. 2009; 30(4):S547-55.
• [13]Ceesay SM, Prentice AM, Cole TJ, Foord F, Weaver LT, Poskitt EM et al.. Effects on birth weight and perinatal mortality of maternal dietary supplements in rural Gambia: 5 year randomised controlled trial. BMJ. 1997; 315(7111):786-90.
• [14]Kramer MS, Kakuma R. Energy and protein intake in pregnancy: Cochrane database of Systematic reviews. Geneva: World Health Organization; 2007. Available at: http://www.cochrane.org/reviews/en/ab000032.html Accessed September 18, 2009.
• [15]Persson LÅ, Arifeen SE, Ekstrom EC, Rasmussen KM, Frongillo EA, Yunus M et al.. Effects of prenatal micronutrient and early food supplementation on hemoglobin, birth weight, and infant mortality among children in Bangladesh: the MINIMat randomized trial. JAMA. 2012; 307(19):2050-9.
• [16]Shaheen R, Streatfield PK, Naved RT, Lindholm L, Persson LÅ. Equity in adherence to and effect of prenatal food and micronutrient supplementation on child mortality: results from the MINIMat randomized trial, Bangladesh. BMC Pub Health. 2014;14(1). doi:10.1186/1471-2458-14-5.
• [17]World Bank. Data table. Washington, D.C.: World Bank; 2014. Online at: http://data.worldbank.org/ Accessed Feb 27, 2015.
• [18]Drummond MF, O’Brien B, Stoddart GL, Torrance GW. Methods for the economic evaluations of health care programs. 2nd ed. Oxford University Press, London; 1997.
• [19]Khan MM, Ahmed S. Relative efficiency of government and non-government organisations in implementing a nutrition intervention programme—a case study from Bangladesh. Public Health Nutr. 2003; 6:19-24.
• [20]Onada. Average exchange rates. http://www.oanda.com/currency/average. Accessed June 7, 2014.
• [21]Bangladesh Bureau of Statistics. Statistical yearbook of Bangladesh: 2005. Dhaka: Statistics Division: Division of Planning, People’s Republic of Bangladesh. Dhaka: Bangladesh Bureau of Statistics; 2005. Available at: http://www.bbs.gov.bd/dataindex/svrs_key06.pdf Accessed Sep 17, 2009.
• [22]Trading Economics. Bangladesh Inflation Rate. Online at: http://www.tradingeconomics.com/bangladesh/inflation-cpi. Accessed June 7, 2014.
• [23]Hossain SM, Duffield A, Taylor A. An evaluation of the impact of a US$60 million nutrition programme in Bangladesh. Health Policy Plan. 2005; 20:35-40.
• [24]World Health Organisation. Cost-effectiveness thresholds. Geneva: World Health Organization; 2009. Online at: http://www.who.int/choice/costs/CER_thresholds/en/. Accessed March 15, 2015.
• [25]LeFevre AE, Shillcutt SD, Waters HR, Haider S, Arifeen SE, Mannan I et al.. Economic evaluation of neonatal care packages in a cluster-randomized controlled trial in Sylhet, Bangladesh. Bull World Health Organ. 2013; 91:736-45.
• [26]Bank W. Maintaining momentum to 2015? An impact evaluation of interventions to improve maternal and child health and nutrition in Bangladesh. Washington, D.C., World Bank; 2005.
• [27]Martines J, Paul VK, Bhutta ZA, Koblinsky M, Soucat A, Walker N et al.. Lancet Neonatal Survival Steering Team: Neonatal survival: a call for action. Lancet. 2005; 365(9465):1189-97.
• [28]Borghi J, Thapa B, Osrin D, Jan S, Morrison J, Tamang S et al.. Economic assessment of a women’s group intervention to improve birth outcomes in rural Nepal. Lancet. 2005; 366(9500):1882-4.
• [29]Batura N, Pulkki-Brännström AM, Agrawal P, Bagra A, Haghparast-Bidgoli H, Bozzani F et al.. Collecting and analysing cost data for complex public health trials: reflections on practice. Glob Health Action. 2014; 7:23257.
• [30]Persson LÅ. Breaking the cycles of malnutrition: are pregnancy nutrition interventions effective? J Health Popul Nutr. 2001; 19(3):158-9.