Cost and cost-effectiveness of PPM-DOTS for tuberculosis control: evidence from India.
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.
Floyd
Katherine
K
HIV/AIDS, TB and Malaria, World Health Organization, 1211 Geneva 27, Switzerland. floydk@who.int
Arora
V K
VK
Murthy
K J R
KJ
Lonnroth
Knut
K
Singla
Neeta
N
Akbar
Y
Y
Zignol
Matteo
M
Uplekar
Mukund
M
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*