Economic evaluation of nutrition interventions: does one size fit all?

Background: Nutrition interventions have specific features that might warrant modifications to the methods used for economic evaluations of healthcare interventions. Aim: The aim of the article is to identify these features and when they challenge the use of cost-utility analysis (CUA). Methods: A critical review of the literature was conducted and a 2 by 2 classification matrix for nutrition interventions was proposed based on 1) who the main party responsible for the implementation and funding of the intervention is; and 2) who the target recipient of the intervention is. The challenges of conducting economic evaluations for each group of nutrition interventions were then analysed according to four main aspects: attribution of effects, measuring and valuing outcomes, inter-sectorial costs and consequences and equity considerations. Results and conclusions: CUA is appropriate for nutrition interventions when they are funded from the healthcare sector, have no (or modest) spill-overs to other sectors of the economy and have only (or mainly) health consequences. For other interventions, typically involving different government agencies, with cost implications for the private sector, with important wellbeing consequences outside health and with heterogeneous welfare effects across socio-economic groups, other economic evaluation methods need to be developed in order to offer valid guidance to policy making. For these interventions, checklists for critical appraisal of economic evaluations may require some substantial changes.