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Multiple micronutrient supplementation vs. iron folic acid: A cost-effectiveness analysis

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Created On: 02/05/2025

A lack of essential micronutrients during pregnancy can escalate the risk of adverse maternal and neonatal outcomes.

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Key take away

Multiple-micronutrient supplementation is a cost-effective alternative to iron-folic acid for pregnant women, especially in low- and middle-income countries.

Background

A lack of essential micronutrients during pregnancy can escalate the risk of adverse maternal and neonatal outcomes. Since 2016, the WHO has recommended multiple-micronutrient supplementation (MMS) over iron folic acid (IFA), backed by evidence portraying its greater efficiency in supporting maternal health.

To strengthen policy decisions, a thorough economic assessment is prudent to determine whether MMS offers a cost-effective alternative to IFA. Hence, this systematic review investigated all published studies on the cost-effectiveness analysis of MMS versus IFA in pregnancy.

Method

Databases like PubMed and Scopus were searched to identify cost-effectiveness studies comparing MMS with IFA in pregnant women. Extracted data covered study characteristics, cost parameters, input variables, cost-effectiveness outcomes, and primary sources of uncertainty. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Result

Following the elimination of 111 duplicate records and the screening of 1201 abstracts, 125 full-text articles were assessed, with 5 studies meeting the inclusion criteria. All studies focused on low- and middle-income countries, consistently showing that MMS is cost-effective—and in some cases, highly cost-effective—when compared to IFA.

Each study employed cost-effectiveness analysis, using the incremental cost-effectiveness ratio (ICER) per disability-adjusted life year (DALY) averted as the primary metric. Findings indicated that shifting from IFA to MMS represents a cost-effective intervention, with ICER values ranging from USD 3.62 to USD 1024 per DALY averted, depending on the economic and healthcare context. The key factor influencing cost-effectiveness was the procurement cost of MMS.

Conclusion

The findings reinforced the economic feasibility of replacing IFA with MMS in certain settings, demonstrating its potential to improve maternal health outcomes at a justifiable cost. The affordability of MMS and the burden of micronutrient deficiencies remain crucial considerations in determining its cost-effectiveness. These insights support the integration of MMS into maternal health policies as a viable, cost-efficient intervention.