Towards the Development of a Universal Metric to Estimate the Cost‐Effectiveness of Nutrition‐Focused Policies to Improve Maternal and Child Health in South Asia
Authors: Pedersen Sarah Hansen , Masters William A , Webb Patrick , Danaei Goodarz , Wright Ashley N , Mozaffarian Dariush 
Published: November 2023

BackgroundGlobally, suboptimal diet is the leading cause of death and disability, yet the most relevant dietary priorities and optimal interventions to effectively reduce the corresponding burdens remain poorly understood. Policy strategies at the organizational, community, and population level are powerful, sustainable and scalable to achieve broad impact on diet‐disease outcomes, yet the cost‐effectiveness of specific dietary interventions are not yet established.ObjectiveWe aim to conduct robust, novel, cost‐effectiveness analyses of specific policy interventions to increase consumption of dietary targets to improve maternal and child health in Bangladesh, India, and Nepal by estimating the costs and public health gains of implementing these population‐level interventions. Our overarching research question is: which interventions will have the greatest impact at the lowest cost?MethodsThe first step in constructing our cost‐effectiveness model was to convene a meeting of regional experts in South Asia. A group of interdisciplinary experts identified nutrition‐focused policies of interest that fell under six broad categories and described the target population of these policies as well as the affected nutrient/food and the mechanisms by which the policy impacts nutrient intake. Additionally, experts identified the resources and costs that would be necessary to implement the policy in the countries of interest.Results17 regional experts from Bangladesh, India, and Nepal identified 30 nutrition‐focused policy interventions that fell under 6 broad categories: (1) Targeted and Conditional Transfer Programs; (2) Mass Media Campaigns and Community‐Based Education; (3) Food Markets and Prices; (4) Small‐Scale Production; (5) Food Processing and Fortification; and (6) Pre‐school and School‐Based Feeding Programs. The majority of identified policies were targeted towards pregnant/lactating women (n=7) and children <5 years (n=6) and aimed to increase intake of a wide range of food items that included: legumes/pulses (n=9), meat/poultry (n=6), eggs (n=6), green leafy vegetables (n=6), and yellow/orange/red fruits and vegetables (n=6). Mass media campaigns and community‐based education were the most commonly identified policy interventions (n=16), followed by small‐scale production (n=8), and targeted and conditional transfer programs (n=6).ConclusionsMulti‐disciplinary regional experts from multiple South Asian countries, coming from diverse institutions and organizations were able to identify priority nutrition‐focused interventions for cost‐effectiveness analysis. Using this information on resources required and costs associated with the identified policies, alongside nutrient intake data from the Global Dietary Database, income, price, and behavior change elasticities extracted from literature reviews, and effect sizes for nutrient‐disease pathways, we will construct a discrete‐time state‐transition microsimulation model to produce an estimate of cost‐effectiveness, expressed in $/DALY, enabling governments, NGOs, and other organizations to prioritize the interventions in which they will invest.Support or Funding InformationBill & Melinda Gates Foundation