Wolfson Institute of Population Health, Queen Mary University of London, England, United Kingdom.
Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.
PLoS One. 2023 Aug 18;18(8):e0290379. doi: 10.1371/journal.pone.0290379. eCollection 2023.
Inadequate nutrition and insufficient stimulation in early childhood can lead to long-term deficits in cognitive and social development. Evidence for policy and decision-making regarding the cost of delivering nutrition education is lacking in low and middle-income countries (LMIC). In rural Uganda, we conducted a cluster-randomized controlled trial (RCT) examining the effect of a maternal nutrition education intervention on developmental outcomes among children aged 6-8 months. This intervention led to significantly improved cognitive scores when the children reached the age of 20-24 months. When considering the potential for this intervention's future implementation, the desired effects should be weighed against the increased costs. This study therefore aimed to assess the cost-effectiveness of this education intervention compared with current practice. Health outcome data were based on the RCT. Cost data were initially identified by reviewing publications from the RCT, while more detailed information was obtained by interviewing researchers involved in processing the intervention. This study considered a healthcare provider perspective for an 18-months' time horizon. The control group was considered as the current practice for the future large-scale implementation of this intervention. A cost-effectiveness analysis was performed, including calculations of incremental cost-effectiveness ratios (ICERs). In addition, uncertainty in the results was characterized using one-way and probabilistic sensitivity analyses. The ICER for the education intervention compared with current practice was USD ($) 16.50 per cognitive composite score gained, with an incremental cost of $265.79 and an incremental cognitive composite score of 16.11. The sensitivity analyses indicated the robustness of these results. The ICER was sensitive to changes in cognitive composite score and the cost of personnel. The education intervention can be considered cost-effective compared with the current practice. The outcome of this study, including the cost analysis, health outcome, cost-effectiveness, and sensitivity analysis, can be useful to inform policymakers and stakeholders about effective resource allocation processes in Uganda and possibly other LMIC.
儿童早期营养不足和刺激不够会导致认知和社会发展的长期缺陷。在低收入和中等收入国家（LMIC），缺乏关于提供营养教育成本的政策和决策证据。在乌干达农村，我们进行了一项群组随机对照试验（RCT），研究了母亲营养教育干预对 6-8 个月大儿童发育结果的影响。当这些儿童长到 20-24 个月大时，该干预措施显著提高了认知评分。当考虑到这种干预措施未来实施的可能性时，应该权衡预期效果和增加的成本。因此，本研究旨在评估与现行做法相比，这种教育干预的成本效益。健康结果数据基于 RCT。成本数据最初通过审查 RCT 的出版物来确定，而更详细的信息则通过采访参与处理干预措施的研究人员获得。本研究从医疗保健提供者的角度考虑了 18 个月的时间范围。控制组被认为是未来大规模实施这种干预措施的现行做法。进行了成本效益分析，包括计算增量成本效益比（ICER）。此外，使用单因素和概率敏感性分析来描述结果的不确定性。与现行做法相比，教育干预的 ICER 为每获得 1 个认知综合评分 16.50 美元，增量成本为 265.79 美元，增量认知综合评分为 16.11。敏感性分析表明了这些结果的稳健性。ICER 对认知综合评分和人员成本的变化敏感。与现行做法相比，教育干预可以被认为是具有成本效益的。本研究的结果，包括成本分析、健康结果、成本效益和敏感性分析，可以为乌干达和其他可能的低收入和中等收入国家的决策者和利益相关者提供有关有效资源分配过程的信息。
