Cost-effective treatment for severely malnourished children: What is the best approach?

In urban Bangladesh, 437 children with severe malnutrition aged 12-60 months were sequentially allocated to treatment either as i) inpatients, ii) day care, or iii) domiciliary care after one week of day care. Average institutional costs (US$) to achieve 80% weight-for-height were respectively $156, $59 and $29/child. As a proportion of the overall costs, staff salaries were the largest component, followed by laboratory tests. Parental costs were highest for domiciliary care, as no food supplements were provided, Nevertheless it was the option most preferred by parents and when the institutional and parental costs were combined, domiciliary care was 1.6 times more cost-effective than day care, and 4.1 times more cost-effective than inpatient care. Conclusion: With careful training and an efficient referral system, domiciliary care preceded by one week of day care is the most cost-effective treatment option for severe malnutrition in this setting.