Cost-Utility Analysis of Nutrient-Dense Supplementation in Undernourished Children in Indonesia

OBJECTIVES: Undernutrition—wasting, stunting, and underweight—is a global health concern, especially in developing countries like Indonesia, according to the World Health Organisation. Undernourished children are more susceptible to infectious diseases such as tuberculosis (TB), pneumonia, acute respiratory infections (ARI), and diarrhoea. Giving nutrient-dense formula (NDF) is a practical intervention for addressing this problem. This study used cost-utility analysis (CUA) to evaluate an NDF supplement in undernourished children aged 0–5. It compared the health outcomes and costs of NDF administration with dietary guidance versus standard care (nutritional advice).

METHODS: A CUA was conducted to assess the costs and QALYs of giving undernourished children NDF compared to non-NDF children. Input parameters included prevalence and disease-related direct medical costs from public domain. A decision tree model evaluated the effects of NDF intervention (400kcal/day/child for 90 days) on the undernutrition prevalence of TB, pneumonia, diarrhoea, and ARI, and the corresponding direct medical costs. TB and pneumonia were estimated once each year, whereas ARI and diarrhoea were assessed four and three times, respectively. Sensitivity analysis was performed and cost/QALY gained was expressed by the incremental cost-effectiveness ratio (ICER).

RESULTS: CUA analysis of NDF intervention has shown a decreased in TB, pneumonia, ARI, and diarrhoea prevalence and treatment costs by 47.2%, 44.7%, 47.2%, and 48.9% and the cases by 1.2 million, 1 million, 2.6 million, and 2 million, respectively. These lead to cost saving IDR 2.46 trillion (€139.97M), 3.88 trillion (€220.44M), and 2.40 trillion (€136.33M), respectively. ICER of IDR 4.41 million/QALY (€250.34/QALY) was below Indonesia's willingness-to-pay criteria of three times GDP/capita.

CONCLUSIONS: Administering NDF to undernourished children is a cost-effective intervention for Indonesia as it reduces the undernutrition prevalence and the corresponding treatment costs of the infectious diseases such TB, pneumonia, ARI, and diarrhoea; thereby benefiting public health.