Using nationally representative estimates from the 2017 Global Burden of Disease study, this study conducted an individual-based dynamic microsimulation of population cohorts from birth to 2 years of age in India, Pakistan, Mali, and Tanzania. The effect of maternal nutritional supplementation on infant birth weight, stunting, and wasting was modeled using effect sizes from Cochrane systematic reviews and published literature. The study compared disability-adjusted life years (DALYs) and incremental cost-effectiveness ratios (ICERs) in a baseline scenario with existing antenatal iron folic acid (IFA) coverage with scenarios where 90% of antenatal care (ANC) attendees receive either universal multiple micronutrient supplementation (MMS), universal Balanced energy-protein (BEP), or MMS and targeted BEP. Results showed that MMS and targeted BEP averts more DALYs and remains cost-effective compared to universal MMS. As countries consider using MMS in alignment with recent WHO guidelines, offering targeted BEP is a cost-effective strategy that can be considered concurrently to maximize benefits and synergize program implementation.
