Cost-Effectiveness of 4 Specialized Nutritious Foods in the Prevention of Stunting and Wasting in Children Aged 6–23 Months in Burkina Faso: A Geographically Randomized Trial

Abstract

Background There is a variety of specialized nutritious foods available for use in programs targeting undernutrition, but evidence supporting the choice of product is limited. Objectives We compared the cost-effectiveness of 4 specialized nutritious foods to prevent stunting and wasting in children aged 6–23 mo in Burkina Faso. Methods Four geographic regions were randomly assigned to 1 of 4 intervention arms: Corn-Soy Blend Plus (CSB+) programmed with separate fortified vegetable oil (the reference food), Corn-Soy-Whey Blend (CSWB; a new formulation) with oil, SuperCereal Plus (SC+), and ready-to-use supplementary food (RUSF). We compared the effects of each intervention arm on growth (length-for-age z score (LAZ), weight-for-length z score (WLZ), end-line stunting (LAZ < −2), and total monthly measurements of wasting (WLZ < −2). Rations were ∼500 kcal/d, distributed monthly. Children were enrolled in the blanket supplementary feeding program at age ∼6 mo and measured monthly for ∼18 mo. Average costs per child reached were linked with effectiveness to compare the cost-effectiveness of each arm with CSB+ with oil. Results In our sample of 6112 children (CSB+, n = 1519; CSWB, n = 1503; SC+, n = 1564; RUSF, n = 1526), none of the foods prevented declines in growth. Children in the SC+ and RUSF arms were not significantly different than those in the CSB+ with oil arm. Children in the CSWB with oil arm experienced higher end-line (measurement at age 22.9–23.9 mo) stunting (OR: 2.07; 95% CI: 1.46, 2.94) and more months of wasting (incidence rate ratio: 1.29; 95% CI: 1.09, 1.51). CSB+ with oil was the least-expensive ration in all costing scenarios ($113–131 2018 US dollars/enrolled child) and similar in effectiveness to SC+ and RUSF, and thus the most cost-effective product for the defined purposes. Conclusions CSB+ with oil was the most cost-effective ration in the prevention of wasting and stunting in this trial. This trial was registered at clinicaltrials.gov as NCT02071563.

Impact of stakeholder perspectives on cost-effectiveness estimates of four specialized nutritious foods for preventing stunting and wasting in children 6–23 months in Burkina Faso

“…This paper presents cost-effectiveness results from the perspectives of multiple stakeholders, and reports sensitivity analyses of cost-effectiveness estimates corresponding to each perspective. It complements all effectiveness findings and the primary cost-effectiveness results from a single program perspective reported elsewhere [19].…”

“…Four regions in rural Sanmatenga Province of Burkina Faso were randomly assigned to one of four intervention arms: Corn Soy Blend Plus with fortified vegetable oil (CSB+ w/oil, reference arm), Corn Soy Whey Blend with fortified vegetable oil (CSWB w/oil), Super Cereal Plus (SC+), or Ready-to-Use Supplementary Food (RUSF). The four regions are comparable across important characteristics as described elsewhere [19].…”

“…The study protocol was approved by Tufts University Institutional Review Board and Ethics Board of the Ministry of Health, Burkina Faso, and registered with ClinicalTrials.gov [NCT02071563] [21]. Details on the population, overall study methods, and programmatic setting were described elsewhere [19].…”

“…This paper reports cost and cost-effectiveness results from the perspectives of multiple stakeholders with sensitivity analyses for each perspective. Results of the base-case scenario from program perspective were reported as the primary cost-effectiveness finding elsewhere [19].…”

“…The wasting model counting monthly measurements did not define LTFU, but rather adjusted for missed measurements in the analysis. More detail about effectiveness data collection, variable selection and modeling procedures is available elsewhere [19].…”