EconomicEvaluationsofChildNutrition InterventionsinLow-andMiddle-Income Countries:SystematicReviewandQuality Appraisal

Abstract

Economicevaluationiscrucialforcost-effectiveresourceallocationtoimprovechildnutritioninlowandmiddle-incomecountries(LMICs).However, thequalityofpublishedeconomicevaluationsinthesesettingsisnotwellunderstood.Thissystematicreviewaimedtoassessthequalityofexisting economic evaluations of child nutrition interventions in LMICs and synthesize the study characteristics and economic evidence. We searched 9 electronicdatabases,includingMEDLINE,withthefollowingconcepts:economicevaluation,children,nutrition,andLMICs.Alltypesofinterventions addressingmalnutrition,includingstunting,wasting,micronutrientdeficiency,andoverweight,wereidentified.Weincludedeconomicevaluations that examined both costs and effects published in English peer-reviewed journals and used the Drummond checklist for quality appraisal. We present findings through a narrative synthesis. Sixty-nine studies with diverse settings, perspectives, time horizons, and outcome measures were included. Most studies used data from sub-Saharan Africa and South Asia and addressed undernutrition. The mortality rate, intervention effect, intervention coverage, cost, and discount rate were reported as predictors among studies that performed sensitivity analyses. Despite the heterogeneity of included studies and the possibility of publication bias, 81% of included studies concluded that nutrition interventions were cost-effective or cost-beneficial, mostly based on a country’s cost-effectiveness thresholds. Regarding quality assessment, the studies published after 2016 met more criteria than studies published before 2016. Most studies had well-stated research questions, forms of economic evaluation, interventions,andconclusions.However,reportingtheperspectiveoftheanalyses,justificationofdiscountrates,anddescribingtheroleoffunders and ethics approval were identified as areas needing improvement. The gaps in the quality of reporting could be improved by consolidated guidanceonthepublicationofeconomicevaluationsandtheuseofappropriatequalityappraisalchecklists.Strengtheningtheevidencebasefor childmalnutritionacrossdifferentregionsisnecessarytoinformcost-effectiveinvestmentinLMICs.Trialregistration:PROSPEROCRD42020194445. AdvNutr2022;13:282–317.