Cost and cost-effectiveness of PPM-DOTS for tuberculosis control : evidence from India

• Published in: Bulletin of the World Health Organization 2006-06, Vol.84 (6), p.437-445
• Main Authors: FLOYD, Katherine, ARORA, V. K, MURTHY, K. J. R, LONNROTH, Knut, SINGLA, Neeta, AKBAR, Y, ZIGNOL, Matteo, UPLEKAR, Mukund
• Format: Article
• Language: English
• Subjects: Bacterial diseases; Benefit cost analysis; Biological and medical sciences; Clinical outcomes; Control; Cost analysis; Cost effectiveness; Cost reduction; Cost-Benefit Analysis; Drugs; Evidence-Based Medicine; Expenditures; General aspects; Health Care Costs; Health care expenditures; Human bacterial diseases; India; Infectious diseases; Medical sciences; Medical treatment; Miscellaneous; Observation; Patients; Physicians; Pilot projects; Private Sector; Public health. Hygiene; Public health. Hygiene-occupational medicine; Public Sector; Public-Private partnerships; Treatment Outcome; Tuberculosis; Tuberculosis - economics; Tuberculosis - prevention & control; Tuberculosis and atypical mycobacterial infections
• ISSN: 0042-9686; 1564-0604
• DOI: 10.2471/BLT.05.024109

To assess the cost and cost-effectiveness of the Public-Private Mix DOTS (PPM-DOTS) strategy for tuberculosis (TB) control in India. We collected data on the costs and effects of pilot PPM-DOTS projects in Delhi and Hyderabad using documentary data and interviews. The cost of PPM-DOTS was compared with public sector DOTS (i.e. DOTS delivered through public sector facilities only) and non-DOTS treatment in the private sector. Costs for 2002 in US$ were assessed for the public sector, private practitioners, and patients/attendants. Effectiveness was measured as the number of cases successfully treated. The average cost per patient treated was US$ 111-123 for PPM-DOTS and public sector DOTS, and US$ 111-172 for non-DOTS treatment in the private sector. From the public sector's perspective, the cost per patient treated was lower in PPM-DOTS projects than in public sector DOTS programmes (US$ 24-33 versus US$ 63). DOTS implementation in either the public or private sectors improved treatment outcomes and substantially lowered costs incurred by patients and their attendants, compared to non-DOTS treatment in the private sector (US$ 50-60 for DOTS compared to over US$ 100 for non-DOTS). The average cost-effectiveness of PPM-DOTS and public sector DOTS was similar, at US$ 120-140 per patient successfully treated, compared to US$ 218-338 for non-DOTS private sector treatment. Incremental cost-effectiveness analysis showed that PPM-DOTS can improve effectiveness while also lowering costs. PPM-DOTS can be an affordable and cost-effective approach to improving TB control in India, and can substantially lower the economic burden of TB for patients.