Objectives: To identify the cost-effectiveness of collaborative arrangements among public and private providers to employ the Directly Observed Treatment short-course (DOTS) strategy for tuberculosis (TB) control in Indonesia. Methods: Three strategies were assessed: hospital out-patient diagnosis with referral to public health centres (PHCs) for treatment, hospital out-patient diagnosis and treatment, and private practitioner referral of suspects to PHCs. The outcome was the number of sputum smear positive TB cases successfully treated. Costs include direct costs to providers and patients. Uncertainty analysis was done for both costs and effectiveness data. Results: The average cost per case successfully treated ranged from US$169 to $567 for different strategies. The cost per additional case successfully treated incremental to existing TB programmes ranged from US$152 to $982. In three of four provinces assessed, there was a clearly preferred strategy or strategies, although the preferred strategy differed by province; in one province a preferred strategy could not be identified. Conclusions: All strategies increased TB case finding, although attribution is tentative because of the study design. Neither collaboration among private practitioners nor among hospitals is clearly preferred based on cost-effectiveness. For hospitals, this study suggests that having hospitals refer patients to health centres is preferable over hospitals administering treatment.

Cost-effectiveness, Indonesia, Public-private mix, Tuberculosis
dx.doi.org/10.1016/j.healthpol.2009.08.004, hdl.handle.net/1765/17004
Health Policy
Erasmus MC: University Medical Center Rotterdam

Johns, B, Probandari, A, Mahendradhata, Y, & Ahmad, R.A. (2009). An analysis of the costs and treatment success of collaborative arrangements among public and private providers for tuberculosis control in Indonesia. Health Policy, 93(2-3), 214–224. doi:10.1016/j.healthpol.2009.08.004