title: Cost and cost-effectiveness of PPM-DOTS for tuberculosis control: evidence from India.
abstract: OBJECTIVE
  To assess the cost and cost-effectiveness of the Public-Private Mix DOTS (PPM-DOTS) strategy for tuberculosis (TB) control in India.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: HIV/AIDS, TB and Malaria, World Health Organization, 1211 Geneva 27, Switzerland. floydk@who.int
authors.forename: Katherine
authors.initials: K
authors.lastname: Floyd
authors.forename: V K
authors.initials: VK
authors.lastname: Arora
authors.forename: K J R
authors.initials: KJ
authors.lastname: Murthy
authors.forename: Knut
authors.initials: K
authors.lastname: Lonnroth
authors.forename: Neeta
authors.initials: N
authors.lastname: Singla
authors.forename: Y
authors.initials: Y
authors.lastname: Akbar
authors.forename: Matteo
authors.initials: M
authors.lastname: Zignol
authors.forename: Mukund
authors.initials: M
authors.lastname: Uplekar
mesh_terms: D003362:Cost-Benefit Analysis; D019317:Evidence-Based Medicine; D017048:Health Care Costs; D007194:India; D019370:Observation; D017149:Private Sector; D017150:Public Sector; D016896:Treatment Outcome; D014376:Tuberculosis / Q000191:economics / Q000517:prevention & control*