Costing of three feeding regimens for home-based management of children with uncomplicated severe acute malnutrition from a randomised trial in India

Garg, Charu C; Mazumder, Sarmila; Taneja, Sunita; Shekhar, Medha; Mohan, Sanjana Brahmawar; Bose, Anuradha; Iyengar, Sharad D; Bahl, Rajiv; Martines, José; Bhandari, Nita

doi:10.1136/bmjgh-2017-000702

Cited by 11 publications

(7 citation statements)

References 10 publications

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“…Several studies of community‐based SAM treatment estimate higher cost per patient admitted than we found in Yako. These range from US$56 per child treated in India (Garg et al, 2018) to US$805 in Ghana (Abdul‐Latif et al, 2014). Cost per child recovered varied from US$114 to US$1041 (Chui et al, 2020) compared to our estimate of US$45 under OptiMA and US$60 for those meeting the WHO definition for SAM at admission.…”

Section: Discussionmentioning

confidence: 99%

Utilization patterns, outcomes and costs of a simplified acute malnutrition treatment programme in Burkina Faso

Sato

Daurès

Phelan³

et al. 2021

Maternal & Child Nutrition

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Access to treatment for acute malnutrition remains a challenge, in part due to the fragmentation of treatment programmes based on case severity. This paper evaluates utilization patterns, outcomes and associated costs for treating acute malnutrition cases among a cohort of children in Burkina Faso. This study is a secondary analysis of a proof-of-concept trial, called Optimizing treatment for acute Malnutrition (OptiMA), conducted in Burkina Faso in 2016. A total of 4958 eligible children whose mid-upper arm circumference (MUAC) was less than 125 mm or with oedema were followed weekly and given ready-to-use therapeutic foods (RUTF). We evaluated the service utilization and outcomes among patients and estimated resource use and variable cost per patient, and examined factors driving variation in resource use. Children with lower initial MUAC level grew faster but required more time to recover than those with higher initial MUAC level. They also had higher rates of death, default and nonresponse. The simplified OptiMA approach for treating acute malnutrition achieved high rates of recovery overall (84%), especially among less severe cases, with modest quantities of RUTF. The average overall variable cost per child admitted was US $38.0 (SD: 20.5

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Section: Discussionmentioning

confidence: 99%

Utilization patterns, outcomes and costs of a simplified acute malnutrition treatment programme in Burkina Faso

Sato

Daurès

Phelan³

et al. 2021

Maternal & Child Nutrition

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“…Sixty-one percent (19/31) of the studies included at least one country in the African Region (Table 3) [147, 150, 152-155, 157, 158, 160-163, 167, 169, 171-174, 176]. Twenty-three percent (7/31) of studies included countries in the South-East Asian region [148,149,151,156,[164][165][166]. Thirteen percent (4/31) of studies included countries in the East Mediterranean [146,157,168,170], and 6% (2/31) of studies included countries in the American region [159,175].…”

Section: General Study Characteristicsmentioning

confidence: 99%

“…There were nine studies in total identified in this group. Three of them reported on the initiation of treatment within the home for infants and children within the age group of 6 to 59 months [146,156,174] (S4 Table ). One of these three studies was conducted in India, and the costs to the government per child treated ranged from $1,779 to $2,047, depending on the type of RUTF used [156] (Table 6; S4 Table ).…”

Section: Management Of Severe Wasting And/or Bilateral Pitting Oedema...mentioning

confidence: 99%

“…Three of them reported on the initiation of treatment within the home for infants and children within the age group of 6 to 59 months [146,156,174] (S4 Table ). One of these three studies was conducted in India, and the costs to the government per child treated ranged from $1,779 to $2,047, depending on the type of RUTF used [156] (Table 6; S4 Table ). Centrally produced RUTF (RUTF-C) incurred the lowest costs, followed by locally prepared RUTF (RUTF-L), with micronutrient-enriched (augmented), energy-dense, home-prepared food (A-HPF) incurring the highest costs.…”

Section: Management Of Severe Wasting And/or Bilateral Pitting Oedema...mentioning

confidence: 99%

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Costs and cost-effectiveness of treatment setting for children with wasting, oedema and growth failure/faltering: A systematic review

Mdege,

Masuku,

Musakwa

et al. 2023

PLOS Glob Public Health

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This systematic review aimed to address the existing evidence gaps, and guide policy decisions on the settings within which to treat infants <12 months of age with growth faltering/failure, and infants and children aged <60 months with moderate wasting or severe wasting and/or bilateral pitting oedema. Twelve electronic databases were searched for studies published before 10 December 2021. The searches yielded 16,709 records from which 31 studies were eligible and included in the review. Three studies were judged as low quality, whilst 14 were moderate and the remaining 14 were high quality. We identified very few cost and cost-effectiveness analyses for most of the models of care with the certainty of evidence being judged at very low or low. However, there were 17 cost and 6 cost-effectiveness analyses for the initiation of treatment in outpatient settings for severe wasting and/or bilateral pitting oedema in infants and children <60 months of age. From this evidence, the costs appear lowest for initiating treatment in community settings, followed by initiating treatment in community and transferring to outpatient settings, initiating treatment in outpatients then transferring to community settings, initiating treatment in outpatient settings, and lastly initiating treatment in inpatient settings. In addition, the evidence suggested that initiation of treatment in outpatient settings is highly cost-effective when compared to doing nothing or no programme implementation scenarios, using country-specific WHO GDP per capita thresholds. The incremental cost-effectiveness ratios ranged from $20 to $145 per DALY averted from a provider perspective, and $68 to $161 per DALY averted from a societal perspective. However, the certainty of the evidence was judged as moderate because of comparisons to do nothing/ no programme scenarios which potentially limits the applicability of the evidence in real-world settings. There is therefore a need for evidence that compare the different available alternatives.

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“…Several studies in India have looked at the cost of services, programs, and conditions,[ 23 , 24 , 25 , 26 , 27 , 28 , 29 ] outpatient and inpatient care at public facilities,[ 30 , 31 , 32 ] and out-of-pocket expenditures (OOPEs) at private facilities. [ 15 , 33 , 34 ] But all these studies pertain to allopathic care.…”

Section: Introductionmentioning

confidence: 99%

Unit costs for allopathic and AYUSH outpatient care in public facilities in Urban Delhi, India

Garg,

Goyanka

2023

Journal of Family Medicine and Primary Care

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Introduction: The National Health Policy, 2017, suggests pluralism in health care with the integrated delivery of AYUSH and allopathic care at public facilities. Information on unit cost of outpatient visits for both types of care at public facilities is useful to guide the policies on health-care delivery. Methods: The costs in 2019–20 were estimated for each type of care at allopathic urban primary health center (UPHC) and AYUSH facilities using top-down methodology and adding out-of-pocket expenditures (OOPE) incurred to reflect true costs. Data from national health survey, annual government budgets, and reports were used. Results: The average cost of an outpatient visit for allopathic care was ₹325 at a UPHC and ₹189 in a homeopathic dispensary and ₹692 in an Ayurvedic dispensary. While OOPE per visit at UPHC was ₹177, no OOPE was incurred at AYUSH facilities. The government expenditure per visit for allopathic care at UPHC at ₹148 was the lowest compared to any type of AYUSH care. The cost per facility for allopathic UPHC was higher than both Ayurvedic and homeopathic dispensaries. Unani dispensaries were least cost-effective, both in terms of cost per visit and cost per facility. Conclusion: Costs per visit at a facility are impacted by footfalls. For Ayurveda, despite lower facility costs as compared to UPHC, per visit costs were higher due to low utilization. Improving evidence-based utilization of AYUSH care is critical for the success of the government policy of mainstreaming AYUSH care at low cost.

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Costing of three feeding regimens for home-based management of children with uncomplicated severe acute malnutrition from a randomised trial in India

Cited by 11 publications

References 10 publications

Utilization patterns, outcomes and costs of a simplified acute malnutrition treatment programme in Burkina Faso

Utilization patterns, outcomes and costs of a simplified acute malnutrition treatment programme in Burkina Faso

Costs and cost-effectiveness of treatment setting for children with wasting, oedema and growth failure/faltering: A systematic review

Unit costs for allopathic and AYUSH outpatient care in public facilities in Urban Delhi, India

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