Effectiveness and cost-effectiveness of 4 supplementary foods for treating moderate acute malnutrition: results from a cluster-randomized intervention trial in Sierra Leone

Stacy P Griswold, Breanne K Langlois, Ye Shen, Ilana R Cliffer, Devika J Suri, Shelley Walton, Ken Chui, Irwin H Rosenberg, Aminata S Koroma, Donna Wegner, Amir Hassan, Mark J Manary, Stephen A Vosti, Patrick Webb, Beatrice L Rogers, Stacy P Griswold, Breanne K Langlois, Ye Shen, Ilana R Cliffer, Devika J Suri, Shelley Walton, Ken Chui, Irwin H Rosenberg, Aminata S Koroma, Donna Wegner, Amir Hassan, Mark J Manary, Stephen A Vosti, Patrick Webb, Beatrice L Rogers

Abstract

Background: Moderate acute malnutrition (MAM) affects 33 million children annually. Investments in formulations of corn-soy blended flours and lipid-based nutrient supplements have effectively improved MAM recovery rates. Information costs and cost-effectiveness differences are still needed.

Objectives: We assessed recovery and sustained recovery rates of MAM children receiving a supplementary food: ready-to-use supplementary food (RUSF), corn soy whey blend with fortified vegetable oil (CSWB w/oil), or Super Cereal Plus with amylase (SC + A) compared to Corn Soy Blend Plus with fortified vegetable oil (CSB+ w/oil). We also estimated differences in costs and cost effectiveness of each supplement.

Methods: In Sierra Leone, we randomly assigned 29 health centers to provide a supplement containing 550 kcal/d for ∼12 wk to 2691 children with MAM aged 6-59 mo. We calculated cost per enrollee, cost per child who recovered, and cost per child who sustained recovery each from 2 perspectives: program perspective and caregiver perspective, combined.

Results: Of 2653 MAM children (98.6%) with complete data, 1676 children (63%) recovered. There were no significant differences in the odds of recovery compared to CSB+ w/oil [0.83 (95% CI: 0.64-1.08) for CSWB w/oil, 1.01 (95% CI: 0.78-1.3) for SC + A, 1.05 (95% CI: 0.82-1.34) for RUSF]. The odds of sustaining recovery were significantly lower for RUSF (0.7; 95% CI 0.49-0.99) but not CSWB w/oil or SC + A [1.08 (95% CI: 0.73-1.6) and 0.96 (95% CI: 0.67-1.4), respectively] when compared to CSB+ w/oil. Costs per enrollee [US dollars (USD)/child] ranged from $105/child in RUSF to $112/child in SC + A and costs per recovered child (USD/child) ranged from $163/child in RUSF to $179/child in CSWB w/oil, with overlapping uncertainty ranges. Costs were highest per sustained recovery (USD/child), ranging from $214/child with the CSB+ w/oil to $226/child with the SC + A, with overlapping uncertainty ranges.

Conclusions: The 4 supplements performed similarly across recovery (but not sustained recovery) and costed measures. Analyses of posttreatment outcomes are necessary to estimate the full cost of MAM treatment. This trial was registered at clinicaltrials.gov as NCT03146897.

Keywords: cost-effectiveness; moderate acute malnutrition; relapse; supplementary feeding program; sustained recovery; wasting.

© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.

Figures

FIGURE 1
FIGURE 1
Trial profile. MUAC error at start was defined as mean of 3 MUAC measurements >12.5 cm or 

FIGURE 2

Cost per child who recovered…

FIGURE 2

Cost per child who recovered from MAM: program perspective compared to program +…

FIGURE 2
Cost per child who recovered from MAM: program perspective compared to program + caregiver perspectives. Error bars for both perspectives use 95% CIs of recovery rate from the adjusted effectiveness model. Error bars for program and caregiver perspectives also incorporate uncertainty around the time cost of caregivers (±1 SD). Abbreviations: CSB+ w/oil, Corn Soy Blend Plus with fortified vegetable oil; CSWB w/oil, corn soy whey blend with fortified vegetable oil; MAM, moderate acute malnutrition; RUSF, ready-to-use supplementary food; SC+ A, Super Cereal Plus with amylase; USD, United States dollar.

FIGURE 3

Cost per child who sustained…

FIGURE 3

Cost per child who sustained recovery from MAM 1 mo after recovery: program…

FIGURE 3
Cost per child who sustained recovery from MAM 1 mo after recovery: program perspective compared to program + caregiver perspectives. Error bars for both perspectives used point estimates of sustained recovery from 2 adjusted models that treated missed visits at 1 mo postintervention, as all sustained recovery and as all relapsed. Error bars for program and caregiver perspectives also incorporate uncertainty around the time cost of caregivers (±1 SD). Abbreviations: CSB+ w/oil, Corn Soy Blend Plus with fortified vegetable oil; CSWB w/oil, corn soy whey blend with fortified vegetable oil; MAM, moderate acute malnutrition; RUSF, ready-to-use supplementary food; SC+ A, Super Cereal Plus with amylase; USD, United States dollar.
FIGURE 2
FIGURE 2
Cost per child who recovered from MAM: program perspective compared to program + caregiver perspectives. Error bars for both perspectives use 95% CIs of recovery rate from the adjusted effectiveness model. Error bars for program and caregiver perspectives also incorporate uncertainty around the time cost of caregivers (±1 SD). Abbreviations: CSB+ w/oil, Corn Soy Blend Plus with fortified vegetable oil; CSWB w/oil, corn soy whey blend with fortified vegetable oil; MAM, moderate acute malnutrition; RUSF, ready-to-use supplementary food; SC+ A, Super Cereal Plus with amylase; USD, United States dollar.
FIGURE 3
FIGURE 3
Cost per child who sustained recovery from MAM 1 mo after recovery: program perspective compared to program + caregiver perspectives. Error bars for both perspectives used point estimates of sustained recovery from 2 adjusted models that treated missed visits at 1 mo postintervention, as all sustained recovery and as all relapsed. Error bars for program and caregiver perspectives also incorporate uncertainty around the time cost of caregivers (±1 SD). Abbreviations: CSB+ w/oil, Corn Soy Blend Plus with fortified vegetable oil; CSWB w/oil, corn soy whey blend with fortified vegetable oil; MAM, moderate acute malnutrition; RUSF, ready-to-use supplementary food; SC+ A, Super Cereal Plus with amylase; USD, United States dollar.

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