Early Intervention and Reduction of Patient Default Improve Cost Effectiveness of a Supplementary Feeding Intervention for HIV+ Malnourished Patients in Ethiopia

Abstract

Objectiveassess marginal cost and cost‐effectiveness of adding a nutritional supplement to standard treatment of wasted HIV+ patients to raise BMI.MethodsSupplement was provided in 8 clinics; 8 non‐randomly assigned comparison clinics provided standard care: ART, counseling. Costs included: supplement, staff time; administrative cost. Patients’ time in clinic visits was tracked.ResultsRecovery was defined as BMI=18.5 for 2 visits. Treatment patients spent more time per visit. Marginal cost per recovered patient was $12,192 for those entering with severe acute malnutrition (SAM=BMI<= 16) and $1980 for those with moderate acute malnutrition (MAM=BMI >; 16 < 18.5) due to low recovery in SAM patients. Default (failure to complete treatment) was high (70.6% treatment; 59.6% comparison). Three models assessed potential effects of reducing default. Reducing default substantially increased recovery rates and reduced marginal cost per recovered patient; costs were much lower for patients entering as MAM than SAM.ConclusionsSupplementation of wasted HIV+ patients should start early for maximum cost‐effectiveness; reducing default greatly increases cost‐effectiveness.No conflict of interest.