Peer-reviewed article
Benefit-cost analysis of an integrated package of interventions during preconception, pregnancy and early childhood in India.
Tarun Shankar Choudhary, Sarmila Mazumder, Sunita Taneja, Ranadip Chowdhury, Ravi Prakash Upadhyay et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study analysed the financial returns of an integrated package of healthcare, nutrition, water, sanitation and psychosocial support delivered to pregnant women and young children in India, compared to routine care. The interventions were previously shown to reduce low birth weight and stunting. The analysis found that every dollar invested in pregnancy and early childhood interventions returned approximately 10 dollars in economic benefits through reduced mortality, illness and increased productivity. The full package of interventions across preconception, pregnancy and early childhood also showed positive economic returns.
Key points
- Pregnancy and early childhood interventions returned 9.9 dollars PPP for every 1 dollar invested
- Preconception-only interventions returned 6.1 dollars PPP per dollar invested
- The full integrated package across all three periods returned 3.7 dollars PPP per dollar invested
- Net monetary benefits ranged from 7,364 to 25,917 dollars PPP depending on the intervention package
- Pregnancy and early childhood interventions showed positive returns (>4.6 dollars PPP) across all sensitivity analysis scenarios
Limitations
The analysis converts health outcomes to monetary values based on assumptions about mortality, morbidity and productivity gains, which may not capture all impacts or may vary by context. The study is set in India and results may not be directly transferable to other countries with different healthcare systems and costs.
Abstract
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.