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Background: Few studies analyze the cost-effectiveness of nutrition interventions in low-income countries, possibly deterring large-scale implementation. Nutrition interventions may have favorable as well as unfavorable effects. The Maternal and Infant Nutrition Interventions in Matlab (MINIMat) with early prenatal food and micronutrient supplementation reduced infant mortality and were reported to be very cost-effective. However, the multiple micronutrients (MMS) resulted in an increased risk of stunted growth in infancy and early childhood. This unfavorable outcome was not included in the previous cost-effectiveness analysis. The aim of this study is to evaluate whether the MINIMat interventions remain cost-effective in view of both favorable (decreased under-five year mortality) and unfavorable (increased stunting) outcomes.

Method: Pregnant women in rural Bangladesh, where food insecurity still is prevalent, were randomized to early (E) or usual (U) invitation 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. E reduced stunting at 4.5 years compared with U, MMS compared with Fe60 increased stunting at 4.5 years while the combination EMMS reduced infant mortality compared with UFe60. The outcome measure used was disability adjusted life years (DALY), a measure of overall disease burden that combines years of life lost due to premature mortality (under five-year mortality) and years lived with disability (stunting). Incremental cost effectiveness ratios were calculated using cost data from already published studies.

Results: By incrementing UFe60F to EMMS, one DALY could be averted at a cost of US$26.

Conclusion: When both favorable and unfavorable outcomes were included in the analysis early prenatal food and multiple micronutrient interventions remained highly cost effective and seem to be meaningful from a public health perspective.