Abstract
BackgroundChildren aged under five years with severe acute malnutrition (SAM) in Africa and Asia have high mortality rates without effective treatment. Primary care-based treatment of SAM can have good outcomes but its cost effectiveness is largely unknown.MethodThis study estimated the cost effectiveness of community-based therapeutic care (CTC) for children with severe acute malnutrition in government primary health care centres in Lusaka, Zambia, compared to no care. A decision tree model compared the costs (in year 2008 international dollars) and outcomes of CTC to a hypothetical 'do-nothing' alternative. The primary outcomes were mortality within one year, and disability adjusted life years (DALYs) after surviving one year. Outcomes and health service costs of CTC were obtained from the CTC programme, local health services and World Health Organization (WHO) estimates of unit costs. Outcomes of doing nothing were estimated from published African cohort studies. Probabilistic and deterministic sensitivity analyses were done.ResultsThe mean cost of CTC per child was $203 (95% confidence interval (CI) $139–$274), of which ready to use therapeutic food (RUTF) cost 36%, health centre visits cost 13%, hospital admissions cost 17% and technical support while establishing the programme cost 34%. Expected death rates within one year of presentation were 9.2% with CTC and 20.8% with no treatment (risk difference 11.5% (95% CI 0.4–23.0%). CTC cost $1760 (95% CI $592–$10142) per life saved and $ 53 (95% CI $18–$306) per DALY gained. CTC was at least 80% likely to be cost effective if society was willing to pay at least $88 per DALY gained. Analyses were most sensitive to assumptions about mortality rates with no treatment, weeks of CTC per child and costs of purchasing RUTF.ConclusionCTC is relatively cost effective compared to other priority health care interventions in developing countries, for a wide range of assumptions.
Highlights
Children aged under five years with severe acute malnutrition (SAM) in Africa and Asia have high mortality rates without effective treatment
Mortality rates with bilateral pedal oedema were assumed to be the same as with mid upper arm circumference (MUAC) of 11 cm or less, as we found in this Community-based therapeutic care (CTC) programme
The model was most sensitive to assumptions about expected mortality without treatment, weeks of CTC per child, effect of HIV on mortality without CTC, hospital referral rate, cost per kilogram of ready to use therapeutic food (RUTF), quantity of RUTF consumed per week and technical support costs (Table 4)
Summary
Children aged under five years with severe acute malnutrition (SAM) in Africa and Asia have high mortality rates without effective treatment. Children aged under five years with severe acute malnutrition (SAM) in Africa have high mortality rates without effective treatment [1,2,3,4,5]. Cost Effectiveness and Resource Allocation 2009, 7:2 http://www.resource-allocation.com/content/7/1/2 of SAM in ambulatory primary health care settings. The key nutritional component of SAM treatment is ready to use therapeutic food (RUTF). This is a nutrient-dense food with a nutrient content/100 kcal that is similar to F100 milk, the diet recommended by the World Health Organization (WHO) in the recovery phase of the SAM treatment [6]. CTC includes supplementary feeding for moderate malnutrition, which is not considered in this study [8]
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