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

Sheila Isanaka, Dale A Barnhart, Christine M McDonald, Robert S Ackatia-Armah, Roland Kupka, Seydou Doumbia, Kenneth H Brown, Nicolas A Menzies, Sheila Isanaka, Dale A Barnhart, Christine M McDonald, Robert S Ackatia-Armah, Roland Kupka, Seydou Doumbia, Kenneth H Brown, Nicolas A Menzies

Abstract

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.

Trial registration: NCT01015950.

Keywords: CSB++; Mali; PlumpySup; Super Cereal; corn soy blend; cost; cost-effectiveness; moderate acute malnutrition; ready to use supplementary foods.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Schematic of decision tree model. MAM, moderate acute malnutrition; SAM, severe acute malnutrition.
Figure 2
Figure 2
Cost-effectiveness acceptability curves for competing treatment strategies, using DALY averted as the outcome. CSB, corn–soy blend; DALY, disability-adjusted life year; GDP, gross domestic product; ICER, incremental cost-effectiveness ratio; LMF, locally milled flour; MI, Misola; RUSF, ready-to-use supplementary food; SAM, severe acute malnutrition.
Figure 3
Figure 3
Tornado diagram of one-way sensitivity analyses on key model parameters. Parameters that changed the ICER by less than US$10 were excluded from the figure. DALY, disability-adjusted life year; ICER, incremental cost-effectiveness ratio; MAM, moderate acute malnutrition; RUSF, ready-to-use supplementary food; SAM, moderate acute malnutrition.
Figure 4
Figure 4
Cost-effectiveness plane (incremental cost per DALY averted) comparing ‘do nothing,’ ‘treat SAM only,’ and 4 MAM treatment strategies. CSB, corn–soy blend; DALY, disability-adjusted life year; LMF, locally milled flour; MI, Misola; RUSF, ready-to-use supplementary food; SAM, severe acute malnutrition.

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Source: PubMed

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