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

Auteurs: Isanaka S Barnhart DA McDonald CM Ackatia-Armah RS Kupka R Doumbia S Brown KH Menzies NA
Référence de l'article: BMJ global health 2019 ; 4(2); e001227. doi: 10.1136/bmjgh-2018-001227. Epub 2019 04 28
CSB++ Mali PlumpySup Super Cereal corn soy blend cost cost-effectiveness moderate acute malnutrition ready to use supplementary foods
eng

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.