Cost Analysis of Community and Inpatient Approaches to Managing Severe Acute Malnutrition in Four Indian States

Due to limited evidence regarding the cost analysis of the community and inpatient approaches of managing severe acute malnutrition (SAM) in the government settings in India, there is a lack of willingness to scale up these programs. This study assessed the treatment costs of uncomplicated SAM using locally prepared nutrient-dense food in the community-based management of acute malnutrition (CMAM) program, delivered through Anganwadi centers, and complicated SAM at nutritional rehabilitation centers (NRCs), in four Indian states.

Costs of treating a child with SAM in the CMAM program and in NRCs were estimated from a provider's perspective in the government settings and compared. Costs were estimated in 2021 US dollars. A one-way sensitivity analysis was performed to assess the robustness of the results.

The costs per child treated in the CMAM program in Telangana, Madhya Pradesh, Odisha, and Chhattisgarh states of India were $167, $122, $165, and $167, respectively. The respective costs per child treated in the inpatient care facilities at NRCs were $249, $331, $170, and $229. The treatment costs for both CMAM and NRCs vary with the number of admissions.

The CMAM intervention to treat uncomplicated SAM cases in the government setting is less costly than their treatment at the NRC. CMAM can effectively complement inpatient management in high-burden states in India.