Benefit-cost analysis of an integrated package of interventions during preconception, pregnancy and early childhood in India.

Background: We have previously shown that an integrated intervention package delivered during preconception, pregnancy and early childhood substantially reduces low birth weight and stunting at 24 months of age compared with routine care. Now we conduct a benefit-cost analysis to estimate the return on investment of this integrated approach in India. This increases the policy relevance of trial results, given the low investment in healthcare in India.

Methods: We used data from 13 500 participants in the Women and Infant Integrated Interventions for Growth Study (WINGS). Integrated delivery of healthcare, nutrition, water, sanitation and hygiene (WaSH), and psychosocial care interventions during preconception period, or pregnancy and early childhood, or both (full package), was compared with routine care. We converted reduction in mortality, morbidity and increase in productivity to monetary values and calculated the benefit-cost ratio. We used primary and secondary trial health outcomes from the WINGS trial to calculate benefits, and we collected costs prospectively during the trial. Uncertainty was explored in a one-way sensitivity analysis. We applied a discount rate of 3% per annum to both costs and benefits, considering the purchasing power parity (PPP) of US dollars in 2021.

Results: Every dollar invested returned 6.1$ PPP for interventions during preconception, 9.9$ PPP for pregnancy and early childhood interventions and 3.7$ PPP for the full package of interventions compared with routine care in the base case scenario. The return to investment was positive (>4.6$ PPP per 1$ PPP invested) for pregnancy and early childhood interventions in all scenarios of the sensitivity analysis. The net monetary benefits of the interventions ranged between 7364 and 25 917$ PPP.

Conclusion: Our results suggest that integrated and concurrent delivery of healthcare, nutrition, WaSH and psychosocial care interventions during pregnancy and early childhood yield positive economic returns.