Alfiani Fitri, Utami Auliasari Meita, Zakiyah Neily, Daud Nur Aizati Athirah, Suwantika Auliya A, Puspitasari Irma M
Doctoral Program in Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia.
Faculty of Health Science, Universitas Muhammadiyah Cirebon, Cirebon, Indonesia.
Int J Womens Health. 2025 Mar 6;17:639-649. doi: 10.2147/IJWH.S489159. eCollection 2025.
Multiple micronutrient deficiencies might increase the adverse outcome during pregnancy and after birth. Considering the WHO recommendations since 2016 and scientific evidence from previous studies that multiple-micronutrient supplementation (MMS) is more effective than iron folic acid (IFA) in improving pregnant women's health, it is imperative to conduct an economic evaluation to assess the cost-effectiveness of MMS compared with IFA.
We conducted a systematic review from PubMed and Scopus to identify the cost-effectiveness analyses of MMS compared to IFA for pregnant women up to January 2024. Data extraction included specific study characteristics, input parameters, cost elements, cost-effectiveness results, and key drivers of uncertainty. This systematic review adhered to The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.
After removing 111 duplicates and following the screening process on the title and abstract of 1201 records, resulting in 125 full-text articles assessed for eligibility, a total of 5 studies fulfilled the inclusion criteria and were included in the review. All included studies were from low- and middle-income countries and demonstrated that MMS compared to IFA for pregnant women is cost-effective and even very cost-effective in some countries. All included studies implemented cost-effectiveness analysis (CEA) and estimated its cost-effectiveness using incremental cost-effectiveness ratio (ICER) per disability-adjusted life years (DALY) averted. Results suggested that the transition from IFA to MMS was cost-effective. The range of ICER per DALY averted in this study is USD 3.62 to USD 1024, depending on the scenario. Overall, the main determinant influencing cost-effectiveness was the cost of MMS procurement.
Our findings highlight that transitioning from IFA to MMS in certain conditions has been proven cost-effective, emphasizing this intervention's economic viability. MMS price and micronutrient deficiency-related disease burden are important determinants in assessing cost-effectiveness.
PROSPERO CRD42022319470.
多种微量营养素缺乏可能会增加孕期及产后的不良结局。鉴于世界卫生组织自2016年以来的建议以及先前研究的科学证据，即多种微量营养素补充剂（MMS）在改善孕妇健康方面比铁叶酸（IFA）更有效，因此有必要进行经济评估，以评估MMS与IFA相比的成本效益。
我们对PubMed和Scopus进行了系统综述，以确定截至2024年1月与IFA相比MMS对孕妇的成本效益分析。数据提取包括具体的研究特征、输入参数、成本要素、成本效益结果以及不确定性的关键驱动因素。本系统综述遵循系统评价与Meta分析的首选报告项目（PRISMA）声明。
在去除111篇重复文献并对1201条记录的标题和摘要进行筛选后，有125篇全文文章被评估是否符合纳入标准，共有5项研究符合纳入标准并被纳入综述。所有纳入研究均来自低收入和中等收入国家，结果表明，与IFA相比，MMS对孕妇具有成本效益，在某些国家甚至具有很高的成本效益。所有纳入研究均进行了成本效益分析（CEA），并使用每避免一个伤残调整生命年（DALY）的增量成本效益比（ICER）来估计其成本效益。结果表明，从IFA过渡到MMS具有成本效益。根据不同情景，本研究中每避免一个DALY的ICER范围为3.62美元至1024美元。总体而言，影响成本效益的主要决定因素是MMS采购成本。
我们的研究结果表明，在某些情况下从IFA过渡到MMS已被证明具有成本效益，强调了这种干预措施的经济可行性。MMS价格和与微量营养素缺乏相关的疾病负担是评估成本效益的重要决定因素。
PROSPERO CRD42022319470
