THE COST AND COST-EFFECTIVENESS OF INTEGRATING WASTING PREVENTION

Objectives: The release of the new WHO guideline on the prevention and treatment of child wasting identified a dearth of rigorous evidence on the cost-effectiveness of wasting-related interventions, and especially so for interventions that integrate prevention into screening. We estimated the cost and cost-effectiveness of integrating prevention interventions - behavior change communication (BCC) and small quantity lipid-based nutrient supplements (SQ-LNS) - into a facility-based platform in Burkina Faso with enhanced BCC and a community-based platform in Mali with standard BCC.

Methods: We used activity-based costing to estimate costs per child-contact, using data from accounting records, interviews, surveys, and observations. We used a Markov model to estimate costs per disability-adjusted life year (DALY) averted using data from the parent randomized controlled trials on impact on wasting incidence and treatment coverage.

Results: In the intervention group in Burkina Faso, the costs per child-contact of facility-based screening, enhanced BCC, and SQ-LNS were $0.85, $4.28, and $8.86, respectively. In Mali, community-based screening, standard BCC, and SQ-LNS costs were $0.57, $0.72, and $4.14, respectively. Unit costs for the intervention group were higher in Burkina Faso than Mali due to higher general program costs, staff/supervision, and SQ-LNS storage/handling. SQ-LNS constituted the largest cost component in both countries. 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.