Social cost effectiveness of 2 systems of treatment of malnourished children, in Chile

Two approaches in the care of malnourished children were evaluated in order to ascertain both their medical and economical effectiveness. One was a group of 745 children under an ambulatory nutritional rehabilitation program that included health care, supplementary foods and nutrition education; a second group of 420 children attended Day Care Centers (8 hours a day and five days per week) where they received a balanced diet, psychomotor stimulation according to age, and health care. The evolution of nutritional status was followed up and plotted against the NCHS/WHO weight-for-height tables. The rate of recovery was unsatisfactory; below 50% in mild cases of malnutrition, and even less in the more severe cases. The average length of time for attaining normality was longer for moderate malnutrition and for the ambulatory program. When the calculation included a correction for the probability of recovery for each system, the advantage of the Day Care Centers became even more evident: the mean length of time for recovery was 33.2% less than the ambulatory program. The social cost per child, per day, was substantially lower in the ambulatory program. The integral calculus of social cost per child, per day, and the corrected mean time for recovery provided the social cost-effectiveness of nutritional recovery. This figure was clearly adventageous for the ambulatory program for all ages and degrees of malnutrition, exception made for moderately malnourished children below two years of age. In this case, the Day Care Centers appeared to be the most effective therapeutic alternative. This type of analysis is a contribution to the evaluation of medico-social programs for the recuperation of malnutrition. The advantage lies in the fact that it allows an optimization in the allocation of resources, when the previous step is the choice of best therapeutic alternative based upon the patient's age and nutritional status.