PLOS Global Public Health · 9 authors, 8 centres
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This systematic review analyzed cost and cost-effectiveness data for different treatment settings for malnourished children under 60 months. The central finding was that initiating treatment in outpatient settings appears highly cost-effective compared to doing nothing, though costs are generally lowest when initiating treatment in community settings.
This systematic review included 31 studies examining costs and cost-effectiveness for treating malnourished infants and children under 60 months. The review identified a severe lack of economic evidence for most care models, particularly for growth faltering/failure in infants under 12 months. For severe wasting and/or bilateral pitting oedema, 17 cost and 6 cost-effectiveness analyses were found. The evidence indicates that initiating treatment in community settings has the lowest costs, while initiating in inpatient settings has the highest. Furthermore, initiating treatment in outpatient settings was found to be highly cost-effective compared to doing nothing, with incremental cost-effectiveness ratios ranging from $20 to $145 per DALY averted from a provider perspective. The certainty of this cost-effectiveness evidence was judged as moderate, primarily due to comparisons being made against 'do nothing' scenarios rather than between active treatment alternatives. The review concludes that more evidence comparing different treatment alternatives is needed to inform policy decisions.
