PROTOCOL OF THE COST EFFECTIVENESS ANALYSIS OF A CMAM INTERVENTION WITH CHILDREN IN INDIA

Introduction: Treatment of SAM in India, which effects 21% of children in India and hugely contributes to deaths and disability burden, has undergone a paradigm shift in recent past with introduction of community based management of severe acute malnutrition (CMAM). This protocol describes the planned cost effectiveness analysis of a CMAM intervention in one block of an eastern India state.

Methods: A cost-effectiveness analysis will be conducted from a societal perspective, measuring programme, provider, household and societal costs. Programme costs will be collected prospectively using a standardised tool. These will be supplemented with time sheets from the program functionaries and project leads to allocate cost to different program components and to allocate joint cost. Direct and indirect costs incurred by providers will be collected from the Nutrition Rehabilitation Center (NRC), key informant interviews and time use surveys. Direct and indirect household costs will be collected using time use and cost collection surveys. Incremental cost-effectiveness ratios (ICERs) will be calculated for the primary outcome measures, i.e. cases treated, cases cured, life years saved and disability adjusted life years (DALYs) averted. Sensitivity analyses will be conducted to assess the robustness of results.

Results: A suggested protocol for conducting the cost effectiveness analysis of the CMAM intervention has been developed which would serve as guidelines for conducting the analysis of similar interventions across different settings.

Conclusion: There is a shortage of robust evidence regarding the cost-effectiveness of CMAM in the context of India. The analysis will help policymakers to understand the relative value for money of this intervention over facility based intervention. This will also contribute to understanding the fiscal space for investment in CMAM. The findings will be disseminated to policymakers and different stakeholders.