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Cost Effectiveness of Community-Based Therapeutic care for Children with Severe Acute Malnutrition in Zambia: decision tree model

Author: Bachmann, M.O.
Year: 2009
Resource type: Report

Reference: Cost effectiveness and Resource Allocation, 7:2 


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.


bachmann-cea-of-ctc-in-lusaka-2009.pdf (PDF, 471kb)

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Bachmann, M.O. (2009). Cost Effectiveness of Community-Based Therapeutic care for Children with Severe Acute Malnutrition in Zambia: decision tree model.



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