Cost analysis of the treatment of severe acute malnutrition in West Africa

Abstract

We present an updated cost analysis to provide new estimates of the cost of providing community-based treatment for severe acute malnutrition, including expenditure shares for major cost categories. We calculated total and per child costs from a provider perspective. We categorized costs into three main activities (outpatient treatment, inpatient treatment, and management/administration) and four cost categories within each activity (personnel; therapeutic food; medical supplies; and infrastructure and logistical support). For each category, total costs were calculated by multiplying input quantities expended in the Médecins Sans Frontières nutrition program in Niger during a 12-month study period by 2015 input prices. All children received outpatient treatment, with 43% also receiving inpatient treatment. In this large, well-established program, the average cost per child treated was €148.86, with outpatient and inpatient treatment costs of €75.50 and €134.57 per child, respectively. Therapeutic food (44%, €32.98 per child) and personnel (35%, €26.70 per child) dominated outpatient costs, while personnel (56%, €75.47 per child) dominated in the cost of inpatient care. Sensitivity analyses suggested lowering prices of medical treatments, and therapeutic food had limited effect on total costs per child, while increasing program size and decreasing use of expatriate staff support reduced total costs per child substantially. Updated estimates of severe acute malnutrition treatment cost are substantially lower than previously published values, and important cost savings may be possible with increases in coverage/program size and integration into national health programs. These updated estimates can be used to suggest approaches to improve efficiency and inform national-level resource allocation.

Recovery time from severe acute malnutrition and associated factors among under-5 children in Yekatit 12 Hospital, Addis Ababa, Ethiopia: a retrospective cohort study

“…For instance, a cost analysis study that compared the costs of outpatient and inpatient treatment in Ethiopia reported the mean cost per child treated to be US$284.56 in an inpatient facility and US$134.88 in an outpatient center. A similar study in West Africa reported that the outpatient and inpatient treatment costs per child were €75.50 and €134.57, respectively [11,12].…”

New approach to simplifying and optimising acute malnutrition treatment in children aged 6–59 months: the OptiMA single-arm proof-of-concept trial in Burkina Faso

“…A programme integrating SAM and MAM treatment in a single MUAC-based protocol using only RUTF showed the cost of RUTF for integrated treatment to be less than half that for standard SAM management (11) . Other studies found that identification and treatment of children earlier in the wasting process led to fewer hospitalisations and that inpatient care was shown to be twice as costly as outpatient SAM management (12,13) . Furthermore, the treatment of MAM has been shown to be cost-effective in reducing mortality risk by more than 10 % (14) .…”

Combined protocol for severe and moderate acute malnutrition in emergencies: Stakeholder perspectives in four countries

“…More efficient and cost‐effective ways of preventing and treating SAM would be much welcomed by stakeholders at national and global levels, given the expense of this intervention, both in children's lives and in budgetary expenditures. A cost analysis of one large, well‐established community‐based program to treat SAM in Niger found an average cost per child of 149 euros (US$ 175 in today's currency), with cost breakdowns of US$ 83 for outpatient treatment costs and US$ 149 for inpatient treatment costs, respectively (Isanaka et al, ). Indeed, among 10 interventions recommended to improve maternal and child nutrition, SAM management was by far the most expensive, estimated at a total cost of $2.6 billion to achieve 90% coverage in the 34 highest‐burden countries (2010 international dollars; Bhutta et al, ).…”

“…(International NGO, Somalia) Global-and regional-level respondents confirmed these issues; one said that "UNICEF and WFP kind of have a turf war going on," since WFP has become increasingly involved in managing MAM (bilateral agency, global level). Another global respondent said: with cost breakdowns of US$ 83 for outpatient treatment costs and US$ 149 for inpatient treatment costs, respectively (Isanaka et al, 2017). Indeed, among 10 interventions recommended to improve maternal and child nutrition, SAM management was by far the most expensive, estimated at a total cost of $2.6 billion to achieve 90% coverage in the 34 highest-burden countries (2010 international dollars; Bhutta et al, 2013).…”