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An analysis of the costs and treatment success of collaborative arrangements among public and private providers for tuberculosis control in Indonesia

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  • Johns, Benjamin
  • Probandari, Ari
  • Mahendradhata, Yodi
  • Ahmad, Riris Andono

Abstract

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.

Suggested Citation

  • Johns, Benjamin & Probandari, Ari & Mahendradhata, Yodi & Ahmad, Riris Andono, 2009. "An analysis of the costs and treatment success of collaborative arrangements among public and private providers for tuberculosis control in Indonesia," Health Policy, Elsevier, vol. 93(2-3), pages 214-224, December.
  • Handle: RePEc:eee:hepoli:v:93:y:2009:i:2-3:p:214-224
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    References listed on IDEAS

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    1. Drummond, Michael F. & Sculpher, Mark J. & Torrance, George W. & O'Brien, Bernie J. & Stoddart, Greg L., 2005. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 3, number 9780198529453, Decembrie.
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    3. Andrew H. Briggs & David E. Wonderling & Christopher Z. Mooney, 1997. "Pulling cost‐effectiveness analysis up by its bootstraps: A non‐parametric approach to confidence interval estimation," Health Economics, John Wiley & Sons, Ltd., vol. 6(4), pages 327-340, July.
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    1. Lucy Cunnama & Gabriela B. Gomez & Mariana Siapka & Ben Herzel & Jeremy Hill & Angela Kairu & Carol Levin & Dickson Okello & Willyanne DeCormier Plosky & Inés Garcia Baena & Sedona Sweeney & Anna Vass, 2020. "A Systematic Review of Methodological Variation in Healthcare Provider Perspective Tuberculosis Costing Papers Conducted in Low- and Middle-Income Settings, Using An Intervention-Standardised Unit Cos," PharmacoEconomics, Springer, vol. 38(8), pages 819-837, August.

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