Cost effectiveness of community-based therapeutic care for children with severe acute malnutrition in Zambia: Decision tree model

被引：57

作者：

Bachmann M.O. ^{[1
]}

机构：

[1] Medical School, University of East Anglia

来源：

Cost Effectiveness and Resource Allocation | / 7卷 / 1期

关键词：

Decision Tree Model; Health Care Intervention; Severe Acute Malnutrition; Cost Effectiveness Estimate; Deterministic Sensitivity Analysis;

D O I：

10.1186/1478-7547-7-2

中图分类号：

学科分类号：

摘要：

Background: Children aged under five years with severe acute malnutrition (SAM) in Africa and Asia have high mortality rates without effective treatment. Primary care-based treatment of SAM can have good outcomes but its cost effectiveness is largely unknown. Method: This study estimated the cost effectiveness of community-based therapeutic care (CTC) for children with severe acute malnutrition in government primary health care centres in Lusaka, Zambia, compared to no care. A decision tree model compared the costs (in year 2008 international dollars) and outcomes of CTC to a hypothetical 'do-nothing' alternative. The primary outcomes were mortality within one year, and disability adjusted life years (DALYs) after surviving one year. Outcomes and health service costs of CTC were obtained from the CTC programme, local health services and World Health Organization (WHO) estimates of unit costs. Outcomes of doing nothing were estimated from published African cohort studies. Probabilistic and deterministic sensitivity analyses were done. Results: The mean cost of CTC per child was $203 (95% confidence interval (CI) $139 - $274), of which ready to use therapeutic food (RUTF) cost 36%, health centre visits cost 13%, hospital admissions cost 17% and technical support while establishing the programme cost 34%. Expected death rates within one year of presentation were 9.2% with CTC and 20.8% with no treatment (risk difference 11.5% (95% CI 0.4-23.0%). CTC cost $1760 (95% CI $592 - $10142) per life saved and $ 53 (95% CI $18 - $306) per DALY gained. CTC was at least 80% likely to be cost effective if society was willing to pay at least $88 per DALY gained. Analyses were most sensitive to assumptions about mortality rates with no treatment, weeks of CTC per child and costs of purchasing RUTF. Conclusion: CTC is relatively cost effective compared to other priority health care interventions in developing countries, for a wide range of assumptions. © 2009 Bachmann; licensee BioMed Central Ltd.

引用

共 31 条

[1]

Pelletier D.L., The relationship between child anthropometry and mortality in developing countries: Implications for policy programs and future research, J Nutr, 124, 10 SUPPL., (1994)

[2]

Pelletier D.L., Low J.W., Johnson C., Msukwa L.A., Child anthropometry and mortality in Malawi: Testing for effect modification by age and length of follow-up and confounding by socioeconomic factors, J Nutr, 124, (1994)

[3]

Vella V., Tomkins A., Ndiku J., Marshal T., Cortinovis I., Anthropometry as a predictor for mortality among Ugandan children, allowing for socio-economic variables, Eur J Clin Nutr, 48, pp. 189-197, (1994)

[4]

Vella V., Tomkins A., Borghesi A., Migliori G.B., Ndiku J., Adriko B.C., Anthropometry and childhood mortality in northwest and southwest Uganda, Am J Publ Health, 83, pp. 1616-1618, (1993)

[5]

Bhutta Z., Ahmed T., Black R.E., Cousens S., Dewey K., Giugliani E., Haider B.A., Kirkwood B., Morris S.S., Sachdev H.P.S., Shekar M., What works? Interventions for maternal and child undernutrition and survival, Lancet, 371, pp. 417-440, (2008)

[6]

Briend A., Lacsala R., Prudhon C., Mounier B., Grellety Y., Golden M.H., Ready-to-use therapeutic food for treatment of marasmus, Lancet, 353, pp. 1767-1768, (1999)

[7]

Briend A., Highly nutrient-dense spreads: A new approach to delivering multiple micronutrients to high-risk groups, Br J Nutr, 85, (2001)

[8]

Bahwere P., Binns P., Collins S., Dent N., Guerrero S., Hallam A., Khara T., Lee J., Mollison S., Myatt M., Saboyo M., Sadler K., Walsh A., Community Based Therapeutic Care. A Field Manual, (2006)

[9]

Collins S., Dent N., Binns P., Bahwere P., Sadler K., Hallam A., Management of severe acute malnutrition in children, Lancet, 368, pp. 1992-2000, (2006)

[10]

Ashworth A., Efficacy and effectiveness of community-based treatment of severe malnutrition, Food Nutr Bull, 27, SUPPL., (2006)

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