evidence-based blog of Filippo Dibari

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Cost-effectiveness of community-based screening and treatment of moderate acute malnutrition in Mali

In Under-nutrition on May 6, 2019 at 3:20 pm

source: BMJ webpage

By Sheila Isanaka1, Dale A Barnhart2, Christine M McDonald3, Robert S Ackatia-Armah4, Roland Kupka5, Seydou Doumbia6, Kenneth H Brown4, Nicolas A Menzies7


Introduction Moderate acute malnutrition (MAM) causes substantial child morbidity and mortality, accounting for 4.4% of deaths and 6.0% of disability-adjusted life years (DALY) lost among children under 5 each year. There is growing consensus on the need to provide appropriate treatment of MAM, both to reduce associated morbidity and mortality and to halt its progression to severe acute malnutrition. We estimated health outcomes, costs and cost-effectiveness of four dietary supplements for MAM treatment in children 6–35 months of age in Mali.

Methods We conducted a cluster-randomised MAM treatment trial to describe nutritional outcomes of four dietary supplements for the management of MAM: ready-to-use supplementary foods (RUSF; PlumpySup); a specially formulated corn–soy blend (CSB) containing dehulled soybean flour, maize flour, dried skimmed milk, soy oil and a micronutrient pre-mix (CSB++; Super Cereal Plus); Misola, a locally produced, micronutrient-fortified, cereal–legume blend (MI); and locally milled flour (LMF), a mixture of millet, beans, oil and sugar, with a separate micronutrient powder. We used a decision tree model to estimate long-term outcomes and calculated incremental cost-effectiveness ratios (ICERs) comparing the health and economic outcomes of each strategy.

Results Compared to no MAM treatment, MAM treatment with RUSF, CSB++, MI and LMF reduced the risk of death by 15.4%, 12.7%, 11.9% and 10.3%, respectively. The ICER was US$9821 per death averted (2015 USD) and US$347 per DALY averted for RUSF compared with no MAM treatment.

Conclusion MAM treatment with RUSF is cost-effective across a wide range of willingness-to-pay thresholds.

Affiliation of the authors:

  1. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  2. Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  3. Children’s Hospital Oakland Research Institute, Oakland, California, USA
  4. Department of Nutrition and Program in International and Community Nutrition, University of California, Davis, CA, USA
  5. United Nations Children’s Fund, Nutrition Section, New York, NY, USA
  6. Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technology of Bamako, Bamako, Mali
  7. Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  8. Correspondence toDr Sheila Isanaka; sisanaka@hsph.harvard.edu
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