Cost-Benefit Analysis of a Multi-Component Breastfeeding Promotion and Support Intervention in a Developing Country: Results from a Randomized Controlled Trial

Abstract

Background: Breastfeeding is associated with a reduction in infant and maternal morbidity and mortality. Despite the well-established recommendations to exclusively breastfeed infants for at least six months, the rate of exclusive breastfeeding in Lebanon and worldwide remains low. Lebanon also suffers from many gaps in its healthcare and nutrition systems, and recently from a severe economic crisis. Previous economic evaluations showed that increasing breastfeeding rates reduced healthcare costs by improving mother and child health and quality of life. However, none of the studies identified the economic effect throughout the first two years of the infant’s life, taking into consideration infant and maternal illnesses, nor included a detailed breakdown of the direct and indirect costs related to breastfeeding. The aim of this study is to conduct a cost-benefit assessment of a multi-component breastfeeding promotion and support intervention that was implemented in a randomized clinical trial involving healthy Lebanese pregnant women who were followed up for two years postpartum.

Methods: This is a prospective study in which secondary analysis was conducted on data generated from a multi-center, two-arm, single-blinded randomized clinical trial to investigate the effect of multi-component breastfeeding promotion and support intervention on six-month exclusive breastfeeding in Lebanese women. The cost-benefit analysis compares infant nutrition costs, maternal and infant health costs, the cost for implementation and delivery of the multi-component breastfeeding intervention, as well as the incurred overall costs between the trial’s intervention and control groups. Additional analyses were conducted to compare the incurred overall costs by the type of infant nutrition: exclusive breastfeeding, mixed feeding, and exclusive formula feeding, irrespective of maternal trial group allocation.

Results: The intervention did not generate monetary benefits during the first month and the first six months. However, the benefits of the intervention were shown at 1 year (benefit-cost ratio = 2.44) and 2 years (benefit-cost ratio = 2.82) post-partum. In addition, there was no difference between both groups in terms of costs of infant nutrition, doctor visits for infant illnesses, infant hospitalizations, infant medications, maternal non-routine doctor visits due to BF, and overall total cost at any time point, in unadjusted and adjusted analyses. Analyses of incurred costs by infant nutrition type revealed that exclusive breastfeeding was associated with a reduction in overall expenditure, and cost of infant hospitalizations during the first six months, and the second year of the infant’s life. Moreover, it was associated with a lower cost of infant medications during the first three months, and during the second year of life.

Conclusion: This study showed that the economic benefits of the multi-component intervention started to show at one-year post-partum. In view of the economic crisis in Lebanon, this study is the first step to enabling policymakers to invest in breastfeeding promotion.