PT  - JOURNAL ARTICLE
AU  - Sheila Isanaka
AU  - Dale A Barnhart
AU  - Christine M McDonald
AU  - Robert S Ackatia-Armah
AU  - Roland Kupka
AU  - Seydou Doumbia
AU  - Kenneth H Brown
AU  - Nicolas A Menzies
TI  - Cost-effectiveness of community-based screening and treatment of moderate acute malnutrition in Mali
AID  - 10.1136/bmjgh-2018-001227
DP  - 2019 Apr 01
TA  - BMJ Global Health
PG  - e001227
VI  - 4
IP  - 2
4099  - http://gh.bmj.com/content/4/2/e001227.short
4100  - http://gh.bmj.com/content/4/2/e001227.full
SO  - BMJ Global Health2019 Apr 01; 4
AB  - Introduction Moderate acute malnutrition (MAM) causes substantial child morbidity and mortality, accounting for 4.4% of deaths and 6.0% of disability-adjusted life years (DALY) lost among children under 5 each year. There is growing consensus on the need to provide appropriate treatment of MAM, both to reduce associated morbidity and mortality and to halt its progression to severe acute malnutrition. We estimated health outcomes, costs and cost-effectiveness of four dietary supplements for MAM treatment in children 6–35 months of age in Mali.Methods We conducted a cluster-randomised MAM treatment trial to describe nutritional outcomes of four dietary supplements for the management of MAM: ready-to-use supplementary foods (RUSF; PlumpySup); a specially formulated corn–soy blend (CSB) containing dehulled soybean flour, maize flour, dried skimmed milk, soy oil and a micronutrient pre-mix (CSB++; Super Cereal Plus); Misola, a locally produced, micronutrient-fortified, cereal–legume blend (MI); and locally milled flour (LMF), a mixture of millet, beans, oil and sugar, with a separate micronutrient powder. We used a decision tree model to estimate long-term outcomes and calculated incremental cost-effectiveness ratios (ICERs) comparing the health and economic outcomes of each strategy.Results Compared to no MAM treatment, MAM treatment with RUSF, CSB++, MI and LMF reduced the risk of death by 15.4%, 12.7%, 11.9% and 10.3%, respectively. The ICER was US$9821 per death averted (2015 USD) and US$347 per DALY averted for RUSF compared with no MAM treatment.Conclusion MAM treatment with RUSF is cost-effective across a wide range of willingness-to-pay thresholds.Trial registration NCT01015950.