Protocol for the Economic Evaluation of a Community-Based Management Model for Severe Acute Malnutrition Using Locally-Sourced Ready-to-Use Therapeutic Food in Niger (2021–2026)

This protocol details the planned economic evaluation of a community-based management (CBM) model for severe acute malnutrition (SAM) in Niger, which uses ready-to-use therapeutic food (RUTF) manufactured from locally-sourced ingredients. The study aims to determine the cost-effectiveness and budget impact of this localised model compared to the standard programme relying on imported RUTF, adopting both health system and societal perspectives. The evaluation will be conducted alongside a larger, non-inferiority cluster-randomised controlled trial implemented from 2021 to 2026 across four regions. A within-trial analysis will be complemented by a decision-analytic model to extrapolate longer-term health and economic outcomes. Primary data on resource use, costs, and clinical outcomes will be collected prospectively. Key outcome measures are the incremental cost per disability-adjusted life year (DALY) averted and the cost per child successfully treated. The analysis will adhere to the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guidelines. Given the high burden of SAM and the financial pressure of imported RUTF on health systems, this evaluation is crucial. Its findings will guide national and regional policy on scaling sustainable, nutrition-sensitive interventions. By rigorously assessing a model integrated with local agricultural value chains, this work supports goals of health sovereignty and resilient food systems, aiming to enhance programme sustainability and reduce costs.