Cost effectiveness of thiamine supplementation in pregnant and post-partum women to prevent infantile beriberi deaths in Northeast India

Background Thiamine deficiency can be fatal if untreated. Lack of affordable confirmatory tests contribute to preventable infant mortality from thiamine deficiency, otherwise known as beriberi. We calculated the potential cost-effectiveness of a thiamine supplementation program among pregnant and postpartum women to prevent infantile beriberi deaths in Northeast India. Methods A decision-tree model was constructed to estimate the lifetime costs and outcomes associated with implementing a 12-month thiamine supplementation program for pregnant and postpartum women, with a primary outcome of prevention of infantile deaths due to beriberi. The model was populated using both primary and secondary data sources including real world evidence from a secondary care hospital in a rural Northeast Indian setting. Results Results of the model indicate that a routine of 6 months antenatal and 6 months postnatal thiamine supplementation program via one multivitamin per day containing 10 milligrams of thiamine is likely to be highly cost effective with an incremental cost effectiveness ratio (ICER) of INR 2386 (USD 27.81 ) per life year saved at a WTP threshold of INR 1, 72,000 (USD 2004.84) (1 x GDP per capita). Conclusion These results indicate that a thiamine supplementation program among pregnant and postpartum women represents a highly cost-effective use of local resources by substantially reducing infantile morbidity and mortality rates associated with beriberi in the northeastern region of India. The study also provides an example of using locally available data in performing CEA in LMIC settings, where high quality cost and effectiveness data are often unavailable.