A simple approach to cost-effectiveness analysis of community-based management of acute malnutrition (CMAM) Programs

Cost-effectiveness analysis (CEA) is a way of examining the costs and health outcomes of one or more interventions. It compares an intervention to another intervention (or the absence of intervention) by estimating how much it costs to gain a unit of a desired health outcome such as a year of life gained, a case of disease cured, or a life saved. Cost-effectiveness analysis provides information on health impacts and costs of an intervention compared to an alternative intervention (or the absence of intervention). Results are presented as a cost-effectiveness ratio which is the is the cost of an intervention divided by changes in health outcomes. Examples include cost per year of life gained, cost per case cured, and cost per life saved. Interventions can then be compared in terms of cost per unit of effectiveness. This handbook covers the types of outcomes used in CEA analyses, the creation of counterfactuals to model the absence of an intervention, building models of program outcomes and costs, accounting for uncertainty in models using fuzzy numbers and fuzzy arithmetic, the types of costs that need to be considered in cost-effectiveness analyses, detailed methods and tools needed to collect and work with costs data from a variety of sources, and guidance on interpreting cost-effectiveness estimates. A method of cost-effectiveness analysis for community management of acute malnutrition (CMAM) programs is presented including worked examples from Bangladesh, Ethiopia, Kenya and Nigeria.