title: 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.
abstract: 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.
  
  
  BACKGROUND
  Maternal and Infant Nutrition Interventions, Matlab; ISRCTN16581394 ; Date of registration: Feb 16, 2009.
authors.affiliation: International Maternal and Child Health, Department of Women's and Children's Health, Akademiska sjukhuset, Uppsala University, Uppsala, SE 751 85, Sweden. Rubina.Shaheen@kbh.uu.se.
authors.forename: Rubina
authors.initials: R
authors.lastname: Shaheen
authors.affiliation: International Maternal and Child Health, Department of Women's and Children's Health, Akademiska sjukhuset, Uppsala University, Uppsala, SE 751 85, Sweden. Lars-Ake.Persson@kbh.uu.se.
authors.forename: Lars Åke
authors.initials: LÅ
authors.lastname: Persson
authors.affiliation: Nossal Institute of Global Health, The University of Melbourne, Melbourne, Australia. shakila@unimelb.edu.au.
authors.forename: Shakil
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: icddr,b: International Centre for Diarrheal Disease Research, Bangladesh, 68 Shaheed Tajuddin Ahmed Sarani Mohakhali, Dhaka, 1212, Bangladesh. pkstreatfield@icddrb.org.
authors.forename: Peter Kim
authors.initials: PK
authors.lastname: Streatfield
authors.affiliation: Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden. Lars.Lindholm@epiph.umu.se.
authors.forename: Lars
authors.initials: L
authors.lastname: Lindholm
mesh_terms: D000328:Adult; D001459:Bangladesh; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data*; D019587:Dietary Supplements / Q000191:economics*; D005260:Female; D005492:Folic Acid / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007501:Iron / Q000191:economics / Q000627:therapeutic use; D018977:Micronutrients / Q000191:economics* / Q000627:therapeutic use; D011247:Pregnancy; D039401:Prenatal Nutritional Physiological Phenomena
chemical_list: D018977:Micronutrients; D005492:Folic Acid; D007501:Iron