Abstract
ABSTRACTBackground: Severe acute malnutrition (SAM) is a major global public health concern. Despite the cost-effectiveness of treatment, ministries of health are often unable to commit the required funds which limits service coverage.Objective: A randomised controlled trial was conducted in Sindh Province, Pakistan, to assess whether adding a point of use water treatment to the treatment of SAM without complications improved its cost-effectiveness. Three treatment strategies – chlorine disinfection (Aquatabs); flocculent disinfection (Procter and Gamble Purifier of Water [P&G PoW]) and Ceramic Filters – were compared to a standard SAM treatment protocol.Methods: An institutional perspective was adopted for costing, considering the direct and indirect costs incurred by the provider. Combining the cost of SAM treatment and water treatment, an average cost per child was calculated for the combined interventions for each arm. The costs of water treatment alone and the incremental cost-effectiveness of each water treatment intervention were also assessed.Results: The incremental cost-effectiveness ratio for Aquatabs was 24 US dollars (USD), making it the most cost-effective strategy. The P&G PoW arm was the next least expensive strategy, costing an additional 149 USD per additional child recovered, though it was also the least effective of the three intervention strategies. The Ceramic Filters intervention was the most costly strategy and achieved a recovery rate lower than the Aquatabs arm and marginally higher than the P&G PoW arm.Conclusions: This study found that the addition of a chlorine or flocculent disinfection point-of-use drinking water treatment intervention to the treatment of SAM without complications reduced the cost per child recovered compared to standard SAM treatment. To inform the feasibility of future implementation, further research is required to understand the costs of government implementation and the associated costs to the community and beneficiary household of receiving such an intervention in comparison with the existing SAM treatment protocol.Trial registration: ClinicalTrials.gov identifier: NCT02751476.
Highlights
Severe acute malnutrition (SAM) is a major global public health concern
Treatment is provided through the Community-based Management of Acute Malnutrition (CMAM) model, of which one component is an outpatient service to treat cases without medical complications, made possible with the development of ready-to-use therapeutic food (RUTF), allowing the majority of treatment to be provided in the home [3]
Note: These costs are prorated for the proportion of children in the randomised controlled trial (RCT) in each study arm and do not reflect the total cost incurred for each input in the entire overarching SAM treatment programme
Summary
Severe acute malnutrition (SAM) is a major global public health concern. Despite the cost-effectiveness of treatment, ministries of health are often unable to commit the required funds which limits service coverage. Treatment is provided through the Community-based Management of Acute Malnutrition (CMAM) model, of which one component is an outpatient service to treat cases without medical complications (cases presenting with complications receive inpatient care), made possible with the development of ready-to-use therapeutic food (RUTF), allowing the majority of treatment to be provided in the home [3]. This approach has been found to achieve comparable effectiveness and superior cost-effectiveness to the previously used inpatient model for the treatment of cases of SAM without complications. The majority of the evidence on costeffectiveness of SAM treatment to date is from the
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