Review of the cost-efficiency and cost-effectiveness of the management of severe wasting in children

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Research snapshot¹

The integration of wasting treatment into national primary healthcare services, treatment at the community level by community health workers as well as new 'simplified approaches' all have the potential to increase the coverage of wasting treatment services. However, robust cost-effectiveness evidence is needed to inform policy-level decision-making in support of scale-up. This review examines the latest available evidence on the cost-efficiency and cost-effectiveness of interventions to treat wasting. The review included peer-reviewed papers and evaluation reports published online since 2000. Eleven cost-effectiveness studies were found including two looking at outpatient versus inpatient care, three looking at community health worker-led care and one at the use of simplified combined protocols. The majority of the studies assessed short-term and small scale programmes. A further 10 publications evaluating cost-efficiency were identified that mostly assessed standard community-based management of acute malnutrition (CMAM) programmes.

Overall, findings indicate that CMAM is cost-effective. There is some evidence that community health worker-led treatment of severe wasting increases cost-effectiveness relative to outpatient treatment alone, particularly in high burden contexts. The combined protocol for treatment of moderate and severe wasting was also found to be cost-effective compared to standard care. The cost per child treated for severe wasting ranged from USD56 to USD805 while the cost per child recovered ranged from USD114 to USD1,041. The high degree of variance in the findings suggests important contextual determinants of cost-efficiency and cost-effectiveness including programme scale, population density, burden of wasting and health system factors. It also reflects differences in the methods used in data collection and analysis with respect to whose costs (only the main implementer, all partners, beneficiary costs) and what costs (training, ready-to-use therapeutic foods, logistics, financial vs non-financial costs) were collected as well as the outputs and outcomes used to measure cost-efficiency and cost-effectiveness.       

The findings point to the need for more cost-efficiency and cost-effectiveness analyses, in particular of large scale and longer-term community-based programmes and new approaches currently being implemented. Data collection for costing activities, cost-efficiency and cost-effectiveness analysis methodologies should be agreed and standardised across the sector to allow comparison within and across contexts to better understand the determinants of cost-efficiency, cost-effectiveness and cost drivers. Economic analyses should be more routinely integrated into programme implementation and monitoring.

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