Establishing a Framework to Assess the Cost-Effectiveness of IIPH's Folic Acid Interventions for Women of Reproductive Age

There is a very high prevalence of folic acid deficiency in developing countries and women suffering from this deficiency during their pregnancies are at an increased risk of having a child with neural tube defects (NTDs). NTDs affects approximately 400,000 births annually. Newborns affected by neural tube defects suffer lifelong physical and mental handicaps, and in cases of severe NTDs, die. NTDs, however, are preventable with proper folic acid interventions for women of reproductive age, often reducing the risk of having a child with NTDs by 72%. This paper aims to conduct a systematic review in order to understand, formulate and propose a framework for assessing the cost-effectiveness of the Indian Institute of Public Health's (IIPH) prospective folic acid interventions in India. Several limitations to the proposal of such a framework (particularly on efficacy vs. effectiveness) are highlighted alongside key findings on integral components to include when conducting a cost-effectiveness analysis on folic acid interventions. These findings (costs/benefits/effectiveness), best practices, and lessons from a programmatic and post-hoc perspective are reported and discussed in the results section. Findings are succinctly summarized into a framework in the discussion section as a recommended checklist for IIPH to utilize when conducting a cost-effectiveness analysis on their future intervention.