IFGH 2010: Cost Effectiveness of Community Based Management of Acute Malnutrition in Malawi

This study assessed the cost-effectiveness of community-based management of acute malnutrition (CMAM) to prevent deaths due to severe acute malnutrition among under- fives.The analysis used a decision tree model to compare the costs and effects of two options to treat severe acute malnutrition: existing health services with CMAM versus without CMAM. The model used outcome and cost data from a CMAM programme in Dowa district, setting out key assumptions regarding treatment-seeking behaviour and mortality outcomes.Our ‘base case’ scenario found that CMAM cost US$42 per disability-adjusted life year (DALY) averted (2007 US$) and US$493 per DALY averted under a ‘worst case’ scenario. The results suggest that CMAM was highly cost-effective in the ‘base case’ as defined by the WHO, as the cost per DALY falls well below Malawi’s 2007 Gross National Income (GNI) per capita of US$250 and is within the range of DALYs reported for other child health interventions. Under a hypothetical ‘worst case’ for all variables, the model indicates CMAM is still cost-effective. The results indicate the decision to scale-up CMAM within essential health services in Dowa was a cost-effective one and that scaling up CMAM in similar contexts is likely to be cost- effective, but . may be affected by contextual and programmatic factors.

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