Sharing the burden of TB/HIV? Costs and financing of public-private partnerships for tuberculosis treatment in South Africa.
OBJECTIVE
To explore the economic costs and sources of financing for different public-private partnership (PPP) arrangements to tuberculosis (TB) provision involving both workplace and non-profit private providers in South Africa. The financing required for the different models from the perspective of the provincial TB programme, provider, and the patient are considered.


METHODS
Two models of TB provider partnerships were evaluated, relative to sole public provision: public-private workplace (PWP) and public-private non-government (PNP). The cost analysis was undertaken from a societal perspective. Costs were collected retrospectively to consider both the financial and economic costs. Patient costs were estimated using a retrospective structured patient interview.


RESULTS
Expansion of PPPs could potentially lead to reduced government sector financing requirements for new patients: government financing would require $609-690 per new patient treated in the purely public model, in contrast to PNP sites which would only need to $130-139 per patient and $36-46 with the PWP model. Moreover, there are no patient costs associated with the treatment in the employer-based facilities and the cost to the patient supervised in the community is, on average, three times lower than in public sector facilities.


CONCLUSIONS
The results suggest that there is a strong economic case for expanding PPP involvement in TB treatment in the process of scaling up. The cost to the government per new patient treated could be reduced by enhanced partnership between the private and public sectors.
Sinanovic
Edina
E
Health Economics Unit, Faculty of Health Sciences, University of Cape Town, South Africa. edina@heu.uct.ac.za
Kumaranayake
Lilani
L
D000995:Antitubercular Agents / Q000191:economics; D003695:Delivery of Health Care / Q000191:economics; D004196:Disease Outbreaks / Q000191:economics; D016527:Drug Costs; D017049:Employer Health Costs; D005381:Financing, Organized / Q000191:economics*; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D017048:Health Care Costs; D006801:Humans; D017146:Models, Organizational; D017149:Private Sector / Q000191:economics*; D017150:Public Sector / Q000191:economics*; D013019:South Africa / Q000453:epidemiology; D014376:Tuberculosis / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology
D000995:Antitubercular Agents