Quantifying the Lifetime Economic Impact of Pediatric Oral Nutritional Supplements in Lower-Middle Income Countries in Asia

OBJECTIVES: To quantify the economic impact of pediatric oral nutritional supplements (ONS) for children at risk for undernutrition in a convenience sample of lower-middle income countries (LMICs).

METHODS: This study developed an economic model examining the impact of pediatric ONS administered for 90 days with nutritional counseling relative to standard of care (SoC) (only counseling) on health and economic outcomes for children aged 2-5 at risk for malnutrition in 12 LMICs in Asia. Outcomes of interest included lifetime earnings, accrued starting at working age (15 years old), and health outcomes measured in quality-adjusted life years (QALYs). Total net incremental value was modeled as the sum of the discounted earnings and QALYs gained (Willingness to Pay (WTP) per QALY was 1.5 times the population-weighted average GDP per capita across the 12 countries) over the individual’s lifetime, net of the cost of the intervention.

RESULTS: Relative to the SoC, using pediatric ONS increased mean height-for-age Z score (HAZ) by 0.125 units (0.4 cm on average). This improvement in height would increase discounted lifetime earnings by $926 per person ($83b across LMICs), and increase quality of life by 0.32 QALYs per person (valued at $1,320) (30m QALY gains, equivalent to $118b across LMICs) with an estimated upfront intervention cost of $210 per person ($19b across LMICs). The total lifetime incremental value of ONS use net of intervention cost was $2,036 per person (or $182b across LMICs). Use of pediatric ONS relative to the SoC produced a 8.29% annualized rate of return. The model was most sensitive to the clinical impact ONS had on childhood HAZ scores, the height-wage premium, and the average annual wage in the country.

CONCLUSIONS: Pediatric ONS use among at-risk children in LMICs is associated with meaningful wage growth and health benefits.