Cost-Effectiveness Analysis and Priority Setting in the Transition from Iron-Folic Acid (IFA) to Multiple Micronutrient Supplementation (MMS) for Pregnant Women in Indonesia.

Introduction: The World Health Organization (WHO) has advocated for multiple micronutrient supplementation (MMS) for pregnant women since 2016 to mitigate the risk of various complications. As a country considering investment in MMS, Indonesia requires an assessment of the cost-effectiveness analysis and priority setting in the transition from IFA to MMS, which is essential in the decision-making process. Methods: An open-access online modelling tool was used to estimate the cost-effectiveness of MMS (ICERs per DALY averted) at national and sub-national levels (38 provinces) in Indonesia. The results were then prioritized via a cost-effectiveness league table, with a deterministic sensitivity analysis testing the robustness of the results. Results: Implementing MMS under 44% and 100% coverage scenarios has the potential to avert 54,897 and 124,766 DALYs in Indonesia, respectively, and produced an equivalent incremental cost-effectiveness ratio (ICER) value of USD 10 per DALY averted, which is regarded as highly cost-effective. Since costs and benefits scale linearly with coverage, ICER per DALY averted stays unchanged. The MMS program is recommended to be prioritized in 18 provinces having favorable ICERs, which are Southwest Papua, Highlands Papua, Bali, West Java, South Kalimantan, North Maluku, West Papua, Aceh, North Sumatra, Central Java, Central Kalimantan, West Sulawesi, Maluku, Yogyakarta, East Java, North Kalimantan, South Sulawesi, and South Papua. Related to the sensitivity analysis, the cost of MMS and IFA are the most significant variables influencing the ICER value. Conclusion: The findings show that the implementation of MMS, in comparison to IFA, produces a highly cost-effective outcome in 44% and 100% scenarios. The MMS implementation strategy may initiate with a 44% coverage scenario across 18 prioritized provinces, subsequently expanding to achieve 100% coverage for all pregnant women in Indonesia.