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A multi-country, prospective cohort study to evaluate the economic implications of relapse among children recovered

Chloe Puett¹, Sarah King², Heather Stobaugh^2,3

¹Department of Family, Population & Preventive Medicine, Program in Public Health, Health Sciences Center, Stony Brook University, Stony Brook, NY, USA. chloepuett@gmail.com.

|November 26, 2022

Insights

Relapse after community-based management of acute malnutrition (CMAM) incurs significant costs. This study quantifies the economic burden of severe acute malnutrition (SAM) relapse compared to sustained recovery, providing crucial data for global nutrition programs.

Area of Science:

Public Health Nutrition
Health Economics
Global Health Interventions

Background:

Community-based management of acute malnutrition (CMAM) effectively treats severe acute malnutrition (SAM) and reduces mortality.
A significant proportion of children do not sustain recovery post-discharge from CMAM programs.
The economic consequences of SAM relapse remain under-researched.

Purpose of the Study:

To assess the economic implications of SAM relapse within CMAM programs.
To compare the cost of treating relapsed SAM cases versus sustained recovery.
To generate data informing strategies to mitigate the financial burden of malnutrition relapse.

Main Methods:

A cost-efficiency analysis protocol for CMAM programs in Mali, Somalia, and South Sudan.
Monthly collection and analysis of cost data across SAM and moderate acute malnutrition treatment components.
Utilizing financial records and staff interviews to accurately quantify costs, including personnel and shared program expenses.

Main Results:

This study will provide the first estimates on the economic implications of SAM relapse in CMAM programs.
The analysis will quantify the average cost per episode of relapsed SAM treatment.
Results will highlight the financial burden associated with sustained recovery versus relapse.

Conclusions:

This research addresses a critical evidence gap regarding the economic impact of SAM relapse.
Findings will raise awareness and provide actionable data for the global nutrition community.
Estimating relapse costs in diverse contexts will enhance the generalizability of findings and inform policy.

Read full analysis

Abstract

Background:

Community-based management of acute malnutrition (CMAM) is an effective intervention at recovering children from severe acute malnutrition (SAM) and preventing mortality. However, there is growing evidence that for many children recovery is not sustained post-discharge. This study will assess the economic implications of relapse by calculating the average cost of treating a case of SAM that relapses after initial CMAM treatment compared to the cost of a case that remains recovered for 6 months post-discharge.

Methods:

This protocol outlines the methods for a cost-efficiency analysis to assess cost per episode of treatment for acute malnutrition for children enrolled in CMAM programs for initial SAM treatment in Mali, Somalia and South Sudan. Cost data will be collected and analyzed on a monthly basis for each CMAM service component (outpatient treatment program for SAM, supplementary feeding program for moderate acute malnutrition, and inpatient stabilization care for SAM with medical complications). Financial data will be extracted from expenditure records from institutional accounting systems where possible. Where these are not present, cost data will be collected via interview and review of financial documents. Staff time allocation interviews will be conducted. This data will be applied to quantify personnel costs, to apportion costs that are shared between programs and to exclude staff time spent on research activities.

Discussion:

This study will provide the first estimates to address the limited evidence on the economic implications of SAM relapse in CMAM programs. Data from this economic analysis will help raise awareness and provide actionable data for the global nutrition community to address the financial burden of relapse. Estimating the cost of relapse in three countries representing different geographic and operational contexts will help in generalizing these results.

Trial Registration:

Registration # IORG0007116, Date of registration: 06/09/2020. This study is not registered as a clinical trial as it is observational research and does not include an intervention. The study has received the required ethical approvals as outlined in the declarations.

Keywords:

Community-based management of acute malnutrition Cost-efficiency analysis Institutional costs Marasmus Post-discharge outcome Relapse Severe acute malnutrition Wasting; kwashiorkor

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