Cargando…

Impact of stakeholder perspectives on cost-effectiveness estimates of four specialized nutritious foods for preventing stunting and wasting in children 6–23 months in Burkina Faso

BACKGROUND: Multiple specialized nutritious food options are programmed for supplementation in humanitarian and development settings. However, comparative cost-effectiveness evidence is lacking, let alone incorporation of perspectives from uncompensated stakeholders. A Burkina Faso trial evaluated t...

Descripción completa

Detalles Bibliográficos
Autores principales: Shen, Ye, Cliffer, Ilana R., Suri, Devika J., Langlois, Breanne K., Vosti, Stephen A., Webb, Patrick, Rogers, Beatrice L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7047349/
https://www.ncbi.nlm.nih.gov/pubmed/32106840
http://dx.doi.org/10.1186/s12937-020-00535-x
_version_ 1783502121372483584
author Shen, Ye
Cliffer, Ilana R.
Suri, Devika J.
Langlois, Breanne K.
Vosti, Stephen A.
Webb, Patrick
Rogers, Beatrice L.
author_facet Shen, Ye
Cliffer, Ilana R.
Suri, Devika J.
Langlois, Breanne K.
Vosti, Stephen A.
Webb, Patrick
Rogers, Beatrice L.
author_sort Shen, Ye
collection PubMed
description BACKGROUND: Multiple specialized nutritious food options are programmed for supplementation in humanitarian and development settings. However, comparative cost-effectiveness evidence is lacking, let alone incorporation of perspectives from uncompensated stakeholders. A Burkina Faso trial evaluated the cost-effectiveness of Corn Soy Blend Plus w/ oil (CSB+ w/oil, reference arm), Corn Soy Whey Blend w/oil (CSWB w/oil), Super Cereal Plus (SC+), and Ready-to-Use Supplementary Food (RUSF) in reducing stunting and wasting among children 6–23 months old. This paper presents cost-effectiveness findings from multiple stakeholders’ perspectives, including caregivers and program volunteers. METHODS: An activity-based costing with ingredients approach was used to summarize cost of the 18-month-long blanket supplementary feeding for each enrolled child (in 2018 USD). Time data were collected using self-reported and observational instruments. Cost-effectiveness relative to CSB+ w/oil assessed incremental cost per enrolled child against incremental outcomes: prevalence of stunting at 23 months of age and number of months of wasting. Two combined perspectives were compared: program (donor, implementer, and volunteer) versus program and caregiver (adding caregiver). RESULTS: A total of 6112 children were enrolled. While similar effectiveness was found in three arms (CSWB w/oil was less effective), costs differed. Product cost and caregiver time to prepare study foods were major drivers of cross-arm cost differences from the respective combined perspective. The two major drivers were used to construct uncertainty ranges of cost per enrolled child from program and caregiver perspective: $317 ($279- $355) in CSB+ w/oil, $350 ($327- $373) in CSWB w/oil, $387 ($371- $403) in RUSF, and $434 ($365- $503) in SC+. Cost from program and caregiver perspective was a substantial increase from program perspective. CSB+ w/oil was most cost-effective in reducing stunting and wasting, and this main finding was robust to changing perspectives and all corresponding sensitivity analyses when uncompensated time was valued at minimum wage ($0.36/h). The break-even point for uncompensated time valuation is >$0.84/h, where RUSF became the most cost-effective from the program and caregiver perspective. Relative cost-effectiveness rankings among the other three arms depended on choice of perspectives, and were sensitive to values assigned to product cost, international freight cost, opportunity cost of time, and outcomes of a hypothetical control. Volunteer opportunity cost did not affect arm comparisons, but lack of compensation resulted in negative financial consequences for caregivers. CONCLUSIONS: Evaluating cost-effectiveness by incorporating uncompensated stakeholders provided crucial implementation insights around nutrition products and programming. TRIAL REGISTRATION: Trial registration number: NCT02071563. Name of registry: ClinicalTrials.gov URL of registry: https://clinicaltrials.gov/ct2/show/NCT02071563?type=Intr&cond=Malnutrition&cntry=BF&draw=2&rank=9 Date of registration: February 26, 2014. Date of enrollment of first participant: July 2014.
format Online
Article
Text
id pubmed-7047349
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-70473492020-03-03 Impact of stakeholder perspectives on cost-effectiveness estimates of four specialized nutritious foods for preventing stunting and wasting in children 6–23 months in Burkina Faso Shen, Ye Cliffer, Ilana R. Suri, Devika J. Langlois, Breanne K. Vosti, Stephen A. Webb, Patrick Rogers, Beatrice L. Nutr J Research BACKGROUND: Multiple specialized nutritious food options are programmed for supplementation in humanitarian and development settings. However, comparative cost-effectiveness evidence is lacking, let alone incorporation of perspectives from uncompensated stakeholders. A Burkina Faso trial evaluated the cost-effectiveness of Corn Soy Blend Plus w/ oil (CSB+ w/oil, reference arm), Corn Soy Whey Blend w/oil (CSWB w/oil), Super Cereal Plus (SC+), and Ready-to-Use Supplementary Food (RUSF) in reducing stunting and wasting among children 6–23 months old. This paper presents cost-effectiveness findings from multiple stakeholders’ perspectives, including caregivers and program volunteers. METHODS: An activity-based costing with ingredients approach was used to summarize cost of the 18-month-long blanket supplementary feeding for each enrolled child (in 2018 USD). Time data were collected using self-reported and observational instruments. Cost-effectiveness relative to CSB+ w/oil assessed incremental cost per enrolled child against incremental outcomes: prevalence of stunting at 23 months of age and number of months of wasting. Two combined perspectives were compared: program (donor, implementer, and volunteer) versus program and caregiver (adding caregiver). RESULTS: A total of 6112 children were enrolled. While similar effectiveness was found in three arms (CSWB w/oil was less effective), costs differed. Product cost and caregiver time to prepare study foods were major drivers of cross-arm cost differences from the respective combined perspective. The two major drivers were used to construct uncertainty ranges of cost per enrolled child from program and caregiver perspective: $317 ($279- $355) in CSB+ w/oil, $350 ($327- $373) in CSWB w/oil, $387 ($371- $403) in RUSF, and $434 ($365- $503) in SC+. Cost from program and caregiver perspective was a substantial increase from program perspective. CSB+ w/oil was most cost-effective in reducing stunting and wasting, and this main finding was robust to changing perspectives and all corresponding sensitivity analyses when uncompensated time was valued at minimum wage ($0.36/h). The break-even point for uncompensated time valuation is >$0.84/h, where RUSF became the most cost-effective from the program and caregiver perspective. Relative cost-effectiveness rankings among the other three arms depended on choice of perspectives, and were sensitive to values assigned to product cost, international freight cost, opportunity cost of time, and outcomes of a hypothetical control. Volunteer opportunity cost did not affect arm comparisons, but lack of compensation resulted in negative financial consequences for caregivers. CONCLUSIONS: Evaluating cost-effectiveness by incorporating uncompensated stakeholders provided crucial implementation insights around nutrition products and programming. TRIAL REGISTRATION: Trial registration number: NCT02071563. Name of registry: ClinicalTrials.gov URL of registry: https://clinicaltrials.gov/ct2/show/NCT02071563?type=Intr&cond=Malnutrition&cntry=BF&draw=2&rank=9 Date of registration: February 26, 2014. Date of enrollment of first participant: July 2014. BioMed Central 2020-02-27 /pmc/articles/PMC7047349/ /pubmed/32106840 http://dx.doi.org/10.1186/s12937-020-00535-x Text en © The Author(s) 2020 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Shen, Ye
Cliffer, Ilana R.
Suri, Devika J.
Langlois, Breanne K.
Vosti, Stephen A.
Webb, Patrick
Rogers, Beatrice L.
Impact of stakeholder perspectives on cost-effectiveness estimates of four specialized nutritious foods for preventing stunting and wasting in children 6–23 months in Burkina Faso
title Impact of stakeholder perspectives on cost-effectiveness estimates of four specialized nutritious foods for preventing stunting and wasting in children 6–23 months in Burkina Faso
title_full Impact of stakeholder perspectives on cost-effectiveness estimates of four specialized nutritious foods for preventing stunting and wasting in children 6–23 months in Burkina Faso
title_fullStr Impact of stakeholder perspectives on cost-effectiveness estimates of four specialized nutritious foods for preventing stunting and wasting in children 6–23 months in Burkina Faso
title_full_unstemmed Impact of stakeholder perspectives on cost-effectiveness estimates of four specialized nutritious foods for preventing stunting and wasting in children 6–23 months in Burkina Faso
title_short Impact of stakeholder perspectives on cost-effectiveness estimates of four specialized nutritious foods for preventing stunting and wasting in children 6–23 months in Burkina Faso
title_sort impact of stakeholder perspectives on cost-effectiveness estimates of four specialized nutritious foods for preventing stunting and wasting in children 6–23 months in burkina faso
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7047349/
https://www.ncbi.nlm.nih.gov/pubmed/32106840
http://dx.doi.org/10.1186/s12937-020-00535-x
work_keys_str_mv AT shenye impactofstakeholderperspectivesoncosteffectivenessestimatesoffourspecializednutritiousfoodsforpreventingstuntingandwastinginchildren623monthsinburkinafaso
AT clifferilanar impactofstakeholderperspectivesoncosteffectivenessestimatesoffourspecializednutritiousfoodsforpreventingstuntingandwastinginchildren623monthsinburkinafaso
AT suridevikaj impactofstakeholderperspectivesoncosteffectivenessestimatesoffourspecializednutritiousfoodsforpreventingstuntingandwastinginchildren623monthsinburkinafaso
AT langloisbreannek impactofstakeholderperspectivesoncosteffectivenessestimatesoffourspecializednutritiousfoodsforpreventingstuntingandwastinginchildren623monthsinburkinafaso
AT vostistephena impactofstakeholderperspectivesoncosteffectivenessestimatesoffourspecializednutritiousfoodsforpreventingstuntingandwastinginchildren623monthsinburkinafaso
AT webbpatrick impactofstakeholderperspectivesoncosteffectivenessestimatesoffourspecializednutritiousfoodsforpreventingstuntingandwastinginchildren623monthsinburkinafaso
AT rogersbeatricel impactofstakeholderperspectivesoncosteffectivenessestimatesoffourspecializednutritiousfoodsforpreventingstuntingandwastinginchildren623monthsinburkinafaso