Egg-a-day and breastfeeding promotion microsimulations: A framework and cost-effectiveness comparison between two MNCH interventions

Abstract

Microsimulation used with cost-effectiveness health research offers a powerful tool for NGOs, policy makers, and governments to make informed decisions on health programs prior to spending. These simulations offer comparisons of health scenarios using parameterization of key variables such as intervention coverage and efficacy of an intervention to produce incremental cost-effectiveness ratios (ICERs). In our analysis, we use Vivarium Public Health, a microsimulation platform, to compare cost-effectiveness of two child health interventions, breastfeeding promotion and complementary feeding with eggs. We run health scenarios of 80% coverage for breastfeeding promotion only, egg complementary feeding only, and a packaged intervention using BFP and eggs in Malawi between 2017 and 2020. In scale-up scenarios, we found 1.4% (95% CI 0.7% – 1.8%) and 7.9% (95% CI 3.4 – 11.3%) reduction in discontinued breastfeeding and non-exclusive breastfeeding risk exposures respectively. Similarly, child wasting, underweight and stunting exposure for children under five were 1.0% (95% CI 0.5% – 1.4%), 4.1% (95% CI 3.3%– 5.1%), and 8.9% (95% CI 5.2% – 14.1%) lower. Lastly, we found that breastfeeding promotion was almost ten times more cost effective than the egg intervention and packaged intervention at $58 (95% CI $31 – $341) per averted DALY.