Nutrition-related education intervention to improve cognitive development among impoverished small children in rural Uganda: A cost-effectiveness analysis

Background Inadequate nutrition intake in early childhood can lead to long-term deficits in cognitive development. The previous trial found that education intervention had improved cognitive development among small children in rural Uganda. However, cost and cost-effectiveness had not been performed. This add-on study, I aimed to see whether the intervention is cost-effective compared with the control group considering both cost and effect. Thus, the intervention can be implemented on a large-scale in Uganda or similar countries. Research objective The objective of this thesis was to assess the cost-effectiveness of the education intervention compared with the control group to improve cognitive development among small children in rural Uganda. Methods Health outcome data was regenerated from the previous RCT. Cost data was sought via interviews with researchers involved in processing the intervention. This study considers a healthcare provider perspective for a two-year time horizon. For the future implementation of this intervention, control group considered as a do-nothing strategy. A standard cost-effectiveness analysis was conducted to assess an incremental cost-effectiveness ratio. Uncertainty around the result was characterized using one-way, two-way and bootstrap analysis. Results The incremental cost-effectiveness ratio (ICER) for education intervention compared with do-nothing strategy was approximately $24.18 per cognitive composite score gained, with an incremental cost of almost $363.46 and an incremental cognitive composite score of 15.03. The education intervention compared with the control group, the ICER was almost $5.8. One-way, two-way sensitivity analyses, and a bootstrapping procedure indicated the robustness of these results. ICER is sensitivity to change in the cost of personnel and cognitive composite score. Conclusion The nutrition educational intervention can be considered cost-effective to improve cognitive development for small children in rural Uganda. The outcome of this study, including the cost, health outcome, cost-effectiveness, and sensitivity analyses, can be a useful tool to inform the policymaker in the resource’s allocation process