Published: November 2012
Ready-to-use therapeutic food (RUTF) is a key element of community-based treatment of severe acute malnutrition, a condition that contributes to more than 1.5 million child deaths each year.1 In 2011, partly in response to the famine in East Africa, GiveWell spoke with several manufacturers of ready-to-use therapeutic foods, including Edesia, MANA, and Valid Nutrition.
Based upon a cursory review of the evidence, it appeared to us that ready-to-use therapeutic foods might be quite cost-effective.2 Our central question in conversations with RUTF manufacturers was whether manufacturing was the key bottleneck preventing the scale-up of ready-to-use therapeutic foods, or whether crucial bottlenecks lay elsewhere (for example, in training health workers to use RUTF or in encouraging health systems to incorporate it).
After speaking with representatives of Edesia, MANA, and Valid Nutrition, we believe that the crucial bottlenecks are not on the manufacturing side. According to an Edesia representative, "it is well understood industry-wide, including by very knowledgeable representatives from UNICEF and the World Food Programme, that the 'key bottleneck preventing the scale-up of ready-to-use foods,' is directly tied to funding, and not to manufacturing."3
As a result, we have de-prioritized further research on RUTF manufacturers in favor of a more thorough review of the evidence, cost-effectiveness, and room for more funding of community-based management of severe acute malnutrition as a whole (of which RUTF is an important part), in order to determine how it compares with other priority interventions.
- Bachmann, Max Oscar. 2010. Cost-effectiveness of community-based treatment of severe acute malnutrition in children. Expert Review of Pharmacoeconomics and Outcomes Research 10(5): 605-612.
- Collins, Steve, et al. 2006a. Key issues in the success of community-based management of severe malnutrition. Food and Nutrition Bulletin 27 (Supp. 3): S49-S82.
- Collins, Steve, et al. 2006b. Management of severe acute malnutrition in children. Lancet 368: 1992-2000.
- GiveWell. Notes from Phone Conversation with Edesia (August 9, 2011) (DOC).
- GiveWell. Notes from Phone Conversation with MANA (August 16, 2011) (DOC).
- GiveWell. Notes from Phone Conversation with Valid Nutrition (August 17, 2011). We have not received permission to post this document.
- Reed, Heidi. Communications Manager for Edesia. Email to GiveWell, October 11, 2012.
“Although the data are imprecise, it is known that the risk of mortality in acute malnutrition is directly related to severity, with moderate wasting associated with an annual mortality rate of 30 to 115 per 1,000 [11–14] and severe wasting associated with a rate of 73 to 187 per 1,000 . Our analysis indicates that this is equivalent to over 1.5 million child deaths associated with severe acute malnutrition and 3.5 million with moderate acute malnutrition every year.” Collins et al. 2006a, Pg S50.
- "Initial data indicate that the cost-effectiveness of emergency community-based therapeutic care is comparable to mainstream child-survival interventions, such as vitamin-A provision or oral rehydration therapy for diarrhoeal disease. Estimates from two established emergency programmes were US$101–197 per admission which is equivalent to between US$12 and US$132 for each year of life gained dependent on the assumptions made for the mortality rates of untreated SAM." Collins et al. 2006b, Pg 1997.
- "Recent studies have reported on costs and outcomes of similar large-scale African programs covering geographically defined populations, with ambulatory care for most children, and initial in-patient stabilization for the minority with most severe disease. In these studies the costs ranged from US$129 to $201 per child, and mortality rates ranged from 1.2 to 9.2%, depending on length of follow-up. A decision tree model based on such a program in Zambia estimated that community-based treatment of severe acute malnutrition in primary-care centers, with hospital access, cost US$203 per case treated, US$1760 per life saved, and US$53 per disability-adjusted life year gained, compared with no treatment. This latter cost per disability-adjusted life year gained suggests that community-based treatment of severe acute malnutrition is cost effective compared with other priority health interventions in low-income countries, and compared with such countries’ national incomes." Bachmann 2010, Pg 605.
Reed, email to GiveWell, October 11, 2012.