Effectiveness of interventions to manage acute malnutrition in children under 5 years of age in low- and middle-income countries: A systematic review

Measurement of benefits in economic evaluations of nutrition interventions in low‐ and middle‐income countries: A systematic review

Economic evaluation of nutrition interventions that compares the costs to benefits is essential to priority‐setting. However, there are unique challenges to synthesizing the findings of multi‐sectoral nutrition interventions due to the diversity of potential benefits and the methodological differences among sectors in measuring them. This systematic review summarises literature on the interventions, sectors, benefit terminology and benefit types included in cost‐effectiveness, cost‐utility and benefit‐cost analyses (CEA, CUA and BCA, respectively) of nutrition interventions in low‐ and middle‐income countries. A systematic search of five databases published from January 2010 to September 2019 with expert consultation yielded 2794 studies, of which 93 met all inclusion criteria. Eighty‐seven per cent of the included studies included interventions delivered from only one sector, with almost half from the health sector (43%), followed by food/agriculture (27%), water, sanitation and hygiene (WASH) (10%), and social protection (8%). Only 9% of studies assessed programmes involving more than one sector (health, food/agriculture, social protection and/or WASH). Eighty‐one per cent of studies used more than one term to refer to intervention benefits. The included studies calculated 128 economic evaluation ratios (57 CEAs, 39 CUAs and 32 BCAs), and the benefits they included varied by sector. Nearly 60% measured a single benefit category, most frequently nutritional status improvements; other health benefits, cognitive/education gains, dietary diversity, food security, knowledge/attitudes/practices and income were included in less than 10% of all ratios. Additional economic evaluation of non‐health and multi‐sector interventions, and incorporation of benefits beyond nutritional improvements (including cost savings) in future economic evaluations is recommended.

Current economic evaluations often underestimate the total sum of benefits that can arise from nutrition interventions. Comprehensive benefit measurement of some nutrition programmes may require further methodological research.

In the near‐term, economic evaluations of multi‐sectoral nutrition interventions should include potential cost savings from improved nutrition in their calculations and assess the potential for benefits unrelated to nutrition. If the range of benefits is diverse and can be monetised, benefit‐cost analysis may be the preferred evaluation method.

Economic evaluations of nutrition‐sensitive interventions from agriculture, water, sanitation and hygiene (WASH), and gender empowerment sectors, are needed to fill an evidence gap on costs and benefits of multisectoral approaches to improved maternal and child health and nutrition.