Cost Analysis of Community and Inpatient Approaches to Managing Severe Acute Malnutrition in Four Indian States.

Background: Due to limited evidence regarding the cost analysis of the community and inpatient approaches of managing severe acute malnutrition (SAM) in the government settings in India, there is a lack of willingness to scale up these programs. This study assessed the treatment costs of uncomplicated SAM using locally prepared nutrient-dense food in the community-based management of acute malnutrition (CMAM) program, delivered through Anganwadi centers, and complicated SAM at nutritional rehabilitation centers (NRCs), in four Indian states. Methods: Costs of treating a child with SAM in the CMAM program and in NRCs were estimated from a provider's perspective in the government settings and compared. Costs were estimated in 2021 US dollars. A one-way sensitivity analysis was performed to assess the robustness of the results. Results: The costs per child treated in the CMAM program in Telangana, Madhya Pradesh, Odisha, and Chhattisgarh states of India were $167, $122, $165, and $167, respectively. The respective costs per child treated in the inpatient care facilities at NRCs were $249, $331, $170, and $229. The treatment costs for both CMAM and NRCs vary with the number of admissions. Conclusion: The CMAM intervention to treat uncomplicated SAM cases in the government setting is less costly than their treatment at the NRC. CMAM can effectively complement inpatient management in high-burden states in India.