Cost-effectiveness of community-based screening and treatment of moderate acute malnutrition in Mali
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...
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BMJ Publishing Group
2019-03-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/4/2/e001227.full |
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| author | Sheila Isanaka Dale A Barnhart Christine M McDonald Robert S Ackatia-Armah Roland Kupka Seydou Doumbia Kenneth H Brown Nicolas A Menzies |
| author_facet | Sheila Isanaka Dale A Barnhart Christine M McDonald Robert S Ackatia-Armah Roland Kupka Seydou Doumbia Kenneth H Brown Nicolas A Menzies |
| author_sort | Sheila Isanaka |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-f7bc4fa194fd4669acbd1e6d02510c65 |
| institution | Kabale University |
| issn | 2059-7908 |
| language | English |
| publishDate | 2019-03-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj-art-f7bc4fa194fd4669acbd1e6d02510c652024-12-15T10:25:07ZengBMJ Publishing GroupBMJ Global Health2059-79082019-03-014210.1136/bmjgh-2018-001227Cost-effectiveness of community-based screening and treatment of moderate acute malnutrition in MaliSheila Isanaka0Dale A Barnhart1Christine M McDonald2Robert S Ackatia-Armah3Roland Kupka4Seydou Doumbia5Kenneth H Brown6Nicolas A Menzies76 Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USAResearch and Training, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda1 Department of Nutrition and Institute for Global Nutrition, University of California Davis, Davis, California, USADepartment of Nutrition and Program in International and Community Nutrition, University of California, Davis, CA, USAUnited Nations Children’s Fund, Nutrition Section, New York, NY, USA6 Faculté de Medecine et d`OdontoStomatologie, Université des Sciences, Techniques et Technologiques de Bamako, Bamako, Mali1 Department of Nutrition and Institute for Global Nutrition, University of California Davis, Davis, California, USACenter for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USAIntroduction 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.https://gh.bmj.com/content/4/2/e001227.full |
| spellingShingle | Sheila Isanaka Dale A Barnhart Christine M McDonald Robert S Ackatia-Armah Roland Kupka Seydou Doumbia Kenneth H Brown Nicolas A Menzies Cost-effectiveness of community-based screening and treatment of moderate acute malnutrition in Mali BMJ Global Health |
| title | Cost-effectiveness of community-based screening and treatment of moderate acute malnutrition in Mali |
| title_full | Cost-effectiveness of community-based screening and treatment of moderate acute malnutrition in Mali |
| title_fullStr | Cost-effectiveness of community-based screening and treatment of moderate acute malnutrition in Mali |
| title_full_unstemmed | Cost-effectiveness of community-based screening and treatment of moderate acute malnutrition in Mali |
| title_short | Cost-effectiveness of community-based screening and treatment of moderate acute malnutrition in Mali |
| title_sort | cost effectiveness of community based screening and treatment of moderate acute malnutrition in mali |
| url | https://gh.bmj.com/content/4/2/e001227.full |
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