Cost-effectiveness of decentralising acute malnutrition treatment with a standard or simplified treatment protocol: an economic evaluation in the region of Gao, Mali
Acute malnutrition treatment coverage remains low, causing significant morbidity and mortality. Decentralising treatment to Community Health Worker (CHW) sites can improve access, but evidence on its cost-effectiveness, and on simplified treatment protocols in conflict settings, is lacking. This study assessed the cost and cost-effectiveness of a hybrid model, delivering treatment at both health facilities and CHW sites using a standard or simplified protocol, compared with facility-only treatment, in the conflict-affected region of Gao, northern Mali.
This economic evaluation was part of a three-arm cluster randomised controlled trial enrolling 2,038 children with acute malnutrition (March 2020–July 2021), assessing cost per child treated, cost per child cured, and cost per disability-adjusted life year (DALY) averted.
The cost per child treated was $272 in the control group, $179 with the standard protocol, and $210 with the simplified protocol. Cost per child cured was $356 in the control group, $219 with the standard protocol, and $226 with the simplified protocol. RUTF (ready-to-use therapeutic food) costs were $5.70 less per child with the simplified protocol. The average cost per DALY averted was $173.10 in the control group, compared with $60.30 for the standard protocol and $53 for the simplified protocol.
Involving CHWs in acute malnutrition treatment reduces cost per child treated and is a cost-effective strategy, due to lower costs and greater coverage in the decentralised model. Switching to a simplified protocol can bring further cost savings, particularly for RUTF, and should be considered where weight-based dosing isn't feasible or RUTF stocks are low.
This publication relates to R2HC funded study: Effectiveness, cost-effectiveness, and coverage of severe acute malnutrition (SAM) treatment delivered by Community Health Workers (CHWs) in Mali and Niger