Cost-effectiveness of decentralising acute malnutrition treatment with a standard or simplified treatment protocol: an economic evaluation in the region of Gao, Mali
Abstract Background Acute malnutrition treatment coverage remains low worldwide, causing significant morbidity and mortality. Decentralisation of treatment to Community Health Worker (CHW) sites has shown to be an effective strategy to improve access and increase coverage, but evidence on the cost a...
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2025-01-01
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| Online Access: | https://doi.org/10.1186/s12889-025-21411-5 |
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| author | Bernardette Cichon Noemí López-Ejeda Salimata Samake Cornelia Aton Abdias Ogobara Dougnon Mahamadou N’tji Samake Aliou Bagayoko Magloire Bunkembo Alexandra Rutishauser-Perera Pilar Charle-Cuellar |
| author_facet | Bernardette Cichon Noemí López-Ejeda Salimata Samake Cornelia Aton Abdias Ogobara Dougnon Mahamadou N’tji Samake Aliou Bagayoko Magloire Bunkembo Alexandra Rutishauser-Perera Pilar Charle-Cuellar |
| author_sort | Bernardette Cichon |
| collection | DOAJ |
| description | Abstract Background Acute malnutrition treatment coverage remains low worldwide, causing significant morbidity and mortality. Decentralisation of treatment to Community Health Worker (CHW) sites has shown to be an effective strategy to improve access and increase coverage, but evidence on the cost and cost-effectiveness of this approach as well the use of simplified treatment protocols in conflict settings is lacking. The objective of this study was to determine cost per child treated as well as the cost-effectiveness of the hybrid model of treatment delivery (where treatment is provided at both health facilities and CHW sites) using either a standard protocol (Intervention 1) or simplified protocol (Intervention 2) compared to standard treatment at health facilities only (Control) in the conflict affected region of Gao in Northern Mali. Methods This economic evaluation was part of a three-arm cluster randomized controlled trial which enrolled 2038 children with moderate and severe acute malnutrition. Outcomes assessed were cost per child treated as well as average and incremental cost-effectiveness ratios for cost per child cured and disability adjusted life year (DALY) averted. A within study trial horizon, from March 2020 to July 2021, was used. Cost data were collected from accountancy records and through key informant interviews using a societal perspective. Treatment admission and outcome data were obtained from the main trial. Results In the base case scenario the cost per child treated was 272 US$, 179 US$ and 210US$ in the Control, Intervention 1 and 2 groups, respectively. Cost per child cured was 356 US$ in the Control, 219 US$ in the Intervention 1 and 226 US$ Intervention 2 groups. Ready-to-use therapeutic foods (RUTF) costs among SAM children treated with a simplified protocol were 5.7 US$ less per child. The average cost per DALY averted was 173.1 US$ in the Control compared to 60.3 US$ in the Intervention 1 and 53 US$ in the Intervention 2. Conclusion This study shows that involving CHWs in acute malnutrition treatment reduces the cost per child treated and is a cost-effective strategy, due to lower treatment costs and greater coverage in the decentralised model. Switching to a simplified protocol in a conflict setting can lead to cost savings particularly in terms of RUTF, and should be considered where weight-based admission, monitoring or dosage is not possible or RUTF stocks are running low. Trial registration The study protocol was registered under reference ISRCTN-60,973,756 on the 15th of October 2020. |
| format | Article |
| id | doaj-art-c03de93dfa7048cf8b2b6fa11811cae6 |
| institution | Kabale University |
| issn | 1471-2458 |
| language | English |
| publishDate | 2025-01-01 |
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| spelling | doaj-art-c03de93dfa7048cf8b2b6fa11811cae62025-01-26T12:56:35ZengBMCBMC Public Health1471-24582025-01-0125111610.1186/s12889-025-21411-5Cost-effectiveness of decentralising acute malnutrition treatment with a standard or simplified treatment protocol: an economic evaluation in the region of Gao, MaliBernardette Cichon0Noemí López-Ejeda1Salimata Samake2Cornelia Aton3Abdias Ogobara Dougnon4Mahamadou N’tji Samake5Aliou Bagayoko6Magloire Bunkembo7Alexandra Rutishauser-Perera8Pilar Charle-Cuellar9Operations Department, Action Against Hunger UKEPINUT Research Group (ref. 920325), Unit of Physical Anthropology, Department of Biodiversity, Ecology and Evolution, Complutense University of MadridNutrition and Health Department, Action Against HungerOperations Department, Action Against Hunger UKWest and Central Africa Regional Office, Action Against HungerNutrition Direction of the General Directorate of Health and Public Hygiene, Ministry of HealthNutrition Direction of the General Directorate of Health and Public Hygiene, Ministry of HealthNutrition and Health Department, Action Against HungerOperations Department, Action Against Hunger UKNutrition and Health Department, Action Against HungerAbstract Background Acute malnutrition treatment coverage remains low worldwide, causing significant morbidity and mortality. Decentralisation of treatment to Community Health Worker (CHW) sites has shown to be an effective strategy to improve access and increase coverage, but evidence on the cost and cost-effectiveness of this approach as well the use of simplified treatment protocols in conflict settings is lacking. The objective of this study was to determine cost per child treated as well as the cost-effectiveness of the hybrid model of treatment delivery (where treatment is provided at both health facilities and CHW sites) using either a standard protocol (Intervention 1) or simplified protocol (Intervention 2) compared to standard treatment at health facilities only (Control) in the conflict affected region of Gao in Northern Mali. Methods This economic evaluation was part of a three-arm cluster randomized controlled trial which enrolled 2038 children with moderate and severe acute malnutrition. Outcomes assessed were cost per child treated as well as average and incremental cost-effectiveness ratios for cost per child cured and disability adjusted life year (DALY) averted. A within study trial horizon, from March 2020 to July 2021, was used. Cost data were collected from accountancy records and through key informant interviews using a societal perspective. Treatment admission and outcome data were obtained from the main trial. Results In the base case scenario the cost per child treated was 272 US$, 179 US$ and 210US$ in the Control, Intervention 1 and 2 groups, respectively. Cost per child cured was 356 US$ in the Control, 219 US$ in the Intervention 1 and 226 US$ Intervention 2 groups. Ready-to-use therapeutic foods (RUTF) costs among SAM children treated with a simplified protocol were 5.7 US$ less per child. The average cost per DALY averted was 173.1 US$ in the Control compared to 60.3 US$ in the Intervention 1 and 53 US$ in the Intervention 2. Conclusion This study shows that involving CHWs in acute malnutrition treatment reduces the cost per child treated and is a cost-effective strategy, due to lower treatment costs and greater coverage in the decentralised model. Switching to a simplified protocol in a conflict setting can lead to cost savings particularly in terms of RUTF, and should be considered where weight-based admission, monitoring or dosage is not possible or RUTF stocks are running low. Trial registration The study protocol was registered under reference ISRCTN-60,973,756 on the 15th of October 2020.https://doi.org/10.1186/s12889-025-21411-5Acute malnutritionWastingSimplified protocolRUTFRUSFCommunity health workers |
| spellingShingle | Bernardette Cichon Noemí López-Ejeda Salimata Samake Cornelia Aton Abdias Ogobara Dougnon Mahamadou N’tji Samake Aliou Bagayoko Magloire Bunkembo Alexandra Rutishauser-Perera Pilar Charle-Cuellar Cost-effectiveness of decentralising acute malnutrition treatment with a standard or simplified treatment protocol: an economic evaluation in the region of Gao, Mali BMC Public Health Acute malnutrition Wasting Simplified protocol RUTF RUSF Community health workers |
| title | Cost-effectiveness of decentralising acute malnutrition treatment with a standard or simplified treatment protocol: an economic evaluation in the region of Gao, Mali |
| title_full | Cost-effectiveness of decentralising acute malnutrition treatment with a standard or simplified treatment protocol: an economic evaluation in the region of Gao, Mali |
| title_fullStr | Cost-effectiveness of decentralising acute malnutrition treatment with a standard or simplified treatment protocol: an economic evaluation in the region of Gao, Mali |
| title_full_unstemmed | Cost-effectiveness of decentralising acute malnutrition treatment with a standard or simplified treatment protocol: an economic evaluation in the region of Gao, Mali |
| title_short | Cost-effectiveness of decentralising acute malnutrition treatment with a standard or simplified treatment protocol: an economic evaluation in the region of Gao, Mali |
| title_sort | cost effectiveness of decentralising acute malnutrition treatment with a standard or simplified treatment protocol an economic evaluation in the region of gao mali |
| topic | Acute malnutrition Wasting Simplified protocol RUTF RUSF Community health workers |
| url | https://doi.org/10.1186/s12889-025-21411-5 |
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