1. Cost-Effectiveness Analysis of Multiple Micronutrient Supplementation (MMS) Compared to Iron Folic Acid (IFA) in Pregnancy: A Systematic Review
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Alfiani F, Utami AM, Zakiyah N, Daud NAA, Suwantika AA, and Puspitasari IM
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cost-effectiveness ,economic evaluation ,iron-folic acid ,multiple micronutrient supplementation ,pregnant woman. ,Gynecology and obstetrics ,RG1-991 - Abstract
Fitri Alfiani,1,2 Auliasari Meita Utami,3 Neily Zakiyah,3,4 Nur Aizati Athirah Daud,5 Auliya A Suwantika,3,4,6 Irma M Puspitasari3,4 1Doctoral Program in Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia; 2Faculty of Health Science, Universitas Muhammadiyah Cirebon, Cirebon, Indonesia; 3Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia; 4Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia; 5Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia; 6Center for Health Technology Assessment, Universitas Padjadjaran, Bandung, IndonesiaCorrespondence: Neily Zakiyah, Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jl. Raya Bandung Sumedang KM 21, Jatinangor, 45363, Indonesia, Tel/Fax +62-22-7796200, Email neily.zakiyah@unpad.ac.idIntroduction: 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.Methods: 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.Results: 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.Conclusion: 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.Registration: PROSPERO CRD42022319470.Keywords: cost-effectiveness, economic evaluation, iron-folic acid, multiple micronutrient supplementation, pregnant woman
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- 2025