Costs of a successful public-private partnership for TB control in an urban setting in Nepal.
BACKGROUND
In South Asia a large number of patients seek treatment for TB from private practitioners (PPs), and there is increasing international interest in involving PPs in TB control. To evaluate the feasibility, effectiveness and costs of public-private partnerships (PPPs) for TB control, a PPP was developed in Lalitpur municipality, Nepal, where it is estimated that 50% of patients with TB are managed in the private sector. From the clinical perspective the PPP was shown to be effective. The aim of this paper is to assess and report on the costs involved in the PPP scheme.


METHODS
The approach to costing took a comprehensive view, with inclusion of costs not only incurred by health facilities but also social costs borne by patients and their escorts. Semi-structured questionnaires and guided interviews were used to collect start-up and recurrent costs for the scheme.


RESULTS
Overall costs for treating a TB patient under the PPP scheme averaged US$89.60. Start-up costs per patient represented 12% of the total budget. Half of recurrent costs were incurred by patients and their escorts, with institutional costs representing most of the rest. Female patients tended to spend more and patients referred from the private sector had the highest reported costs.


CONCLUSIONS
Treating TB patients in the PPP scheme had a low additional cost, while doubling the case notification rate and maintaining a high success rate. Costs incurred by patients and their escorts were the largest contributors to the overall total. This suggests a focus for follow-up studies and for cost-minimisation strategies.
Karki
Deepak K
DK
Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences and Public Health Research, University of Leeds, Leeds, UK. dekarki@wlink.com.np <dekarki@wlink.com.np>
Mirzoev
Tolib N
TN
Green
Andrew T
AT
Newell
James N
JN
Baral
Sushil C
SC
D003140:Communicable Disease Control / Q000191:economics* / Q000458:organization & administration; D003299:Cooperative Behavior; D003365:Costs and Cost Analysis; D005260:Female; D006265:Health Care Coalitions; D006801:Humans; D007373:Interinstitutional Relations; D007857:Leadership; D008297:Male; D008518:Medicine, East Asian Traditional; D009390:Nepal; D011331:Private Practice / Q000191:economics*; D016730:Program Development; D011635:Public Health Administration / Q000191:economics*; D011795:Surveys and Questionnaires; D014376:Tuberculosis / Q000175:diagnosis / Q000517:prevention & control*; D019037:Urban Health Services / Q000191:economics / Q000458:organization & administration*; D014838:Volunteers