The Cost and Cost-Effectiveness of an Integrated Wasting Prevention and Screening Intervention Package in Burkina Faso and Mali

Rebecca L Brander; Chloe Puett; Elodie Becquey; Jef L Leroy; Marie T Ruel; Fidele Eric Sessou; Lieven Huybregts

doi:10.1016/j.tjnut.2024.04.010

The Cost and Cost-Effectiveness of an Integrated Wasting Prevention and Screening Intervention Package in Burkina Faso and Mali

J Nutr. 2024 Apr 8:S0022-3166(24)00179-2. doi: 10.1016/j.tjnut.2024.04.010. Online ahead of print.

Authors

Rebecca L Brander¹, Chloe Puett², Elodie Becquey³, Jef L Leroy³, Marie T Ruel³, Fidele Eric Sessou⁴, Lieven Huybregts³

Affiliations

¹ Nutrition, Diets, and Health Unit, International Food Policy Research Institute, Washington, DiC, United States. Electronic address: r.brander@cgiar.org.
² Department of Family, Population and Preventive Medicine, Program in Public Health, Health Sciences Center, Stony Brook University, Stony Brook, NY, United States.
³ Nutrition, Diets, and Health Unit, International Food Policy Research Institute, Washington, DiC, United States.
⁴ UNICEF Innocenti Global Office of Research and Foresight, Florence, Italy.

PMID: 38599389
DOI: 10.1016/j.tjnut.2024.04.010

Abstract

Background: Little is known about costs and cost effectiveness of interventions that integrate wasting prevention into screening for child wasting.

Objectives: This study's objective was to estimate the cost and cost-effectiveness of an intervention that integrated behavior change communication (BCC) and small-quantity lipid-based nutrient supplements (SQ-LNS) into platforms for wasting screening in Burkina Faso (a facility-based platform, where BCC was enhanced compared with standard care) and Mali (a community-based platform, with standard BCC).

Methods: Activity-based costing was used to estimate the cost per child-contact for the intervention and the comparison group, which did not receive the intervention. Costs were ascertained from accounting records, interviews, surveys, and observations. The number of child-contacts was calculated using population size estimates and average attendance rates for each service. Costs per disability-adjusted life year (DALY) averted were estimated using a Markov model populated with data from the parent trials on impact of wasting incidence and treatment coverage.

Results: In the intervention group in Burkina Faso, the cost per child-contact of facility-based screening was $0.85 of enhanced BCC was $4.28, and of SQ-LNS was $8.86. In Mali, the cost per child-contact of community-based screening was $0.57, standard BCC was $0.72, and SQ-LNS was $4.14. Although no SQ-LNS costs were incurred in the comparison groups (hence lower total costs), costs per child-contact for screening and BCC were higher because coverage of these services was lower. The intervention package cost $1073 per DALY averted in Burkina Faso and $747 in Mali.

Conclusions: Integration of wasting prevention into screening for child wasting led to higher total costs but lower unit costs than standard screening due to increased coverage. Greater cost-effectiveness could be achieved if BCC were strengthened and led to improved caregiver health and nutrition practices and if screening triggered appropriate use of services and higher treatment coverage.

Keywords: Burkina Faso; Mali; SQ-LNS; cost; cost-effectiveness; economic evaluation; moderate acute malnutrition; nutrition supplementation; service coverage; severe acute malnutrition; small-quantity lipid-based nutrient supplements; wasting prevention; wasting screening.