Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Cost Effectiveness and Resource Allocation
Published in: Cost Effectiveness and Resource Allocation 1/2009

Open Access 01-12-2009 | Research

Cost effectiveness of community-based therapeutic care for children with severe acute malnutrition in Zambia: decision tree model

Author: Max O Bachmann

Published in: Cost Effectiveness and Resource Allocation | Issue 1/2009

Login to get access

Abstract

Background

Children aged under five years with severe acute malnutrition (SAM) in Africa and Asia have high mortality rates without effective treatment. Primary care-based treatment of SAM can have good outcomes but its cost effectiveness is largely unknown.

Method

This study estimated the cost effectiveness of community-based therapeutic care (CTC) for children with severe acute malnutrition in government primary health care centres in Lusaka, Zambia, compared to no care. A decision tree model compared the costs (in year 2008 international dollars) and outcomes of CTC to a hypothetical 'do-nothing' alternative. The primary outcomes were mortality within one year, and disability adjusted life years (DALYs) after surviving one year. Outcomes and health service costs of CTC were obtained from the CTC programme, local health services and World Health Organization (WHO) estimates of unit costs. Outcomes of doing nothing were estimated from published African cohort studies. Probabilistic and deterministic sensitivity analyses were done.

Results

The mean cost of CTC per child was $203 (95% confidence interval (CI) $139–$274), of which ready to use therapeutic food (RUTF) cost 36%, health centre visits cost 13%, hospital admissions cost 17% and technical support while establishing the programme cost 34%. Expected death rates within one year of presentation were 9.2% with CTC and 20.8% with no treatment (risk difference 11.5% (95% CI 0.4–23.0%). CTC cost $1760 (95% CI $592–$10142) per life saved and $ 53 (95% CI $18–$306) per DALY gained. CTC was at least 80% likely to be cost effective if society was willing to pay at least $88 per DALY gained. Analyses were most sensitive to assumptions about mortality rates with no treatment, weeks of CTC per child and costs of purchasing RUTF.

Conclusion

CTC is relatively cost effective compared to other priority health care interventions in developing countries, for a wide range of assumptions.
Appendix
Available only for authorised users
Literature
1.
Pelletier DL: The relationship between child anthropometry and mortality in developing countries: implications for policy programs and future research. J Nutr 1994,124(10 Suppl):2047S-2081S.PubMed
2.
Pelletier DL, Low JW, Johnson C, Msukwa LA: Child anthropometry and mortality in Malawi: testing for effect modification by age and length of follow-up and confounding by socioeconomic factors. J Nutr 1994, 124: 2082S-2105S.PubMed
3.
Vella V, Tomkins A, Ndiku J, Marshal T, Cortinovis I: Anthropometry as a predictor for mortality among Ugandan children, allowing for socio-economic variables. Eur J Clin Nutr 1994, 48: 189–97.PubMed
4.
Vella V, Tomkins A, Borghesi A, Migliori GB, Ndiku J, Adriko BC: Anthropometry and childhood mortality in northwest and southwest Uganda. Am J Publ Health 1993, 83: 1616–8. 10.2105/AJPH.83.11.1616CrossRef
5.
Bhutta Z, Ahmed T, Black RE, Cousens S, Dewey K, Giugliani E, Haider BA, Kirkwood B, Morris SS, Sachdev HPS, Shekar M, Maternal and Child Undernutrition Study Group: What works? Interventions for maternal and child undernutrition and survival. Lancet 2008, 371: 417–440. 10.1016/S0140-6736(07)61693-6PubMedCrossRef
6.
Briend A, Lacsala R, Prudhon C, Mounier B, Grellety Y, Golden MH: Ready-to-use therapeutic food for treatment of marasmus. Lancet 1999, 353: 1767–1768. 10.1016/S0140-6736(99)01078-8PubMedCrossRef
7.
Briend A: Highly nutrient-dense spreads: a new approach to delivering multiple micronutrients to high-risk groups. Br J Nutr 2001,85(Suppl 2):S175-S179.PubMedCrossRef
8.
Bahwere P, Binns P, Collins S, Dent N, Guerrero S, Hallam A, Khara T, Lee J, Mollison S, Myatt M, Saboyo M, Sadler K, Walsh A: Community Based Therapeutic Care. A Field Manual. Oxford, Valid International; 2006.
9.
Collins S, Dent N, Binns P, Bahwere P, Sadler K, Hallam A: Management of severe acute malnutrition in children. Lancet 2006, 368: 1992–2000. 10.1016/S0140-6736(06)69443-9PubMedCrossRef
10.
Ashworth A: Efficacy and effectiveness of community-based treatment of severe malnutrition. Food Nutr Bull 2006,27(Suppl):S24-S48.PubMed
11.
Ciliberto MA, Sandige H, Ndekha MJ, Ndekha MJ, Ashorn P, Briend A, Ciliberto HM, Manary MJ: Comparison of home-based therapy with ready-to-use therapy with standard therapy in the treatment of malnourished Malawian children: a controlled, health centre effectiveness trial. Am J Clin Nutr 2005, 81: 864–870.PubMed
12.
Patel MP, Sandige HL, Ndekha MJ, Briend A, Ashorn P, Manary MJ: Supplemental feeding with ready-to-use therapeutic food in Malawian children at risk of malnutrition. J Health Pop Nutr 2005, 23: 351–357.
13.
Ashworth A, Khanum S: Cost-effective treatment for severely malnourished children: what it the best approach? Health Policy Plan 1997, 12: 115–121. 10.1093/heapol/12.2.115PubMedCrossRef
14.
Drummond MF, Sculpher MJ, Torrance GW, O'Brien B, Stoddart GL: Methods for the Economic Evaluation of Health Care Programmes. 3rd edition. Oxford, Oxford University Press; 2005.
15.
Tan-Torres Edejer T, Baltussen R, Adam T, Hutubessy R, Acharya A, Evans DB, Murray CJL, (Eds): Making Choices in Health: WHO Guide To Cost-Effectiveness Analysis. Geneva, WHO; 2003.
16.
17.
18.
Amadi B, Kelly P, Mwiya M, Mulwazi E, Sianongo S, Changwe F, Thomson M, Hachungula J, Watuka A, Walker-Smith J, Chintu C: Intestinal and systemic infection, HIV, and mortality in Zambian children with persistent diarrhoea and malnutrition. J Ped Gastr Nutr 2001, 32: 550–554. 10.1097/00005176-200105000-00011CrossRef
19.
20.
21.
22.
23.
24.
Adam T, Evans DB, Murray CJ: Econometric estimation of country-specific hospital costs. Cost Effect Res Allocation 2003, 1: 3. 10.1186/1478-7547-1-3CrossRef
25.
Ades AE, Claxton K, Sculpher M: Evidence synthesis, parameter correlation and probabilistic sensitivity analysis. Health Econs 2006, 15: 373–381. 10.1002/hec.1068CrossRef
26.
Tan-Torres Edejer T, Aikins M, Black R, Wolfson L, Hutubessy R, Evans DB: Cost effectiveness analysis of strategies for child health in developing countries. BMJ 2005, 331: 1177. 10.1136/bmj.38652.550278.7CCrossRef
27.
Prabhat JHA, Bangohoura O, Ranson K: The cost-effectiveness of forty health interventions in Guinea. Health Policy Plan 1998, 13: 249–262. 10.1093/heapol/13.3.249CrossRef
28.
29.
Hutubessy R, Chisholm D, Tan-Torres Edejer T, WHO-CHOICE: Generalized cost-effectiveness analysis for national-level priority setting in the health sector. Cost Effect Res Allocation 2003, 1: 8. 10.1186/1478-7547-1-8CrossRef
30.
Baltussen RMPM, Hutubessy RCW, Evans DB, Murray CLJ: Uncertainty in cost-effectiveness analysis: probabilistic uncertainty analysis and stochastic league tables. Int J Technol Assess Health 2002, 18: 112–119.
31.
UNICEF: The State of the World's Children 2008. Child Survival. New York: UNICEF; 2007.
32.
Berkley J, Mwangi I, Griffiths K, Ahmed I, Mithwani S, English M, Newton C, Maitland K: Assessment of severe malnutrition among hospitalized children in rural Kenya: comparison of weight for height and mid upper arm circumference. JAMA 2005, 294: 591–597. 10.1001/jama.294.5.591PubMedCrossRef
33.
Bitwe R, Dramaix M, Hennart P: Simplified prognostic model of overall intrahospital mortality of children in central Africa. Trop Med Int Health 2006, 11: 73–80. 10.1111/j.1365-3156.2005.01540.xPubMedCrossRef
Metadata
Title
Cost effectiveness of community-based therapeutic care for children with severe acute malnutrition in Zambia: decision tree model
Author
Max O Bachmann
Publication date
01-12-2009
Publisher
BioMed Central
Published in
Cost Effectiveness and Resource Allocation / Issue 1/2009
Electronic ISSN: 1478-7547
DOI
https://doi.org/10.1186/1478-7547-7-2

Other articles of this Issue 1/2009

Cost Effectiveness and Resource Allocation 1/2009 Go to the issue

Research

The costs of a sexually transmitted infection outreach and treatment programme targeting most at risk youth in Tajikistan

Editorial

Cost-Effectiveness and Resource Allocation (CERA) – directions for the future

Research

Cost estimates of HIV care and treatment with and without anti-retroviral therapy at Arba Minch Hospital in southern Ethiopia

Research

Cost-effectiveness analysis of the available strategies for diagnosing malaria in outpatient clinics in Zambia

Research

Comparing the performance of the EQ-5D and SF-6D when measuring the benefits of alleviating knee pain

Research

Estimating average inpatient and outpatient costs and childhood pneumonia and diarrhoea treatment costs in an urban health centre in Zambia