Estimating the cost-effectiveness of nutrition supplementation for malnourished, HIV-infected adults starting antiretroviral therapy in a resource-constrained setting

Table 2 Comparison of nutritional content and estimated costs of potential supplements

	Ready-to-use therapeutic food [27], [28]	Corn-soya blend flour [26]	Common sub-Saharan African staple foods [26]
	Ready-to-use therapeutic food [27], [28]	Corn-soya blend flour [26]	Maize meal (yellow)	Rice (white)
Grams:	100	100	100	100
Calories:	557	376	366	365
Protein grams (% kcal):	14 (10%)	17 (18%)	8.5 (9%)	7.1 (8%)
Fat grams (% kcal):	35 (59%)	7.0 (17%)	1.7 (4%)	0.7 (2%)
Carbohydrate % kcal:	31%	65%	87%	90%
Indication:	Moderate to severe malnutrition	Mild to moderate malnutrition	Staple food	Staple food
Ingredients:	Plumpy’Nut: vegetable fat, peanut paste, skimmed milk powder, whey powder, malto-dextrin, sugar, mineral and vitamin complex.	Corn and soy blend flour, soybean oil, mineral and vitamin complex.
Kilograms needed to supply 1,360 kcal/day for 3 months*	21.97	32.55	33.44	33.53
Estimated cost per kilogram (USD)	$2.18†	$0.48†	$0.296‡	$0.540‡
Estimated cost to provide 1,360 kcal/day for 3 months (USD)^Ω	$47.89	$15.66	$9.90	$18.11

Note: cost-effectiveness models provide a threshold value for supplement costs, however the selection of a specific product would be highly dependent on the local cost of delivering the supplement to patients.
*The figure of 1,360 kcal/day represents 50% of the WFP recommended minimum daily intake of 2100 kcal for adults, increased by an additional 30% (the upper limit of the estimated increase in resting metabolic rate in advanced HIV infection).
†Reported costs per kilogram for locally produced, peanut-based ready-to-use spread and corn-soya blend flour from a nutrition supplementation trial in Malawi by Ndekha et al. [12].
‡Annual average price in 2012 for US #2 yellow maize and white broken rice (Thai A1 Super). Source: Food and Agriculture Organisation of the United Nations (http://www.fao.org/es/esc/prices). Current prices may be higher.
^ΩExcludes all external costs (transport, storage, etc.).

ISSN: 1478-7547