title: Economic evaluation of public-private mix for tuberculosis care and control, India. Part II. Cost and cost-effectiveness.
abstract: METHODS
  Bangalore City, India.
  
  
  OBJECTIVE
  To assess the cost and cost-effectiveness of public-private mix (PPM) for tuberculosis (TB) care and control when implemented on a large scale.
  
  
  METHODS
  DOTS implementation under the Revised National TB Control Programme (RNTCP) began in 1999, PPM was introduced in mid-2001 and a second phase of intensified PPM began in 2003. Data on the costs and effects of TB treatment from 1999 to 2005 were collected and used to compare the two distinct phases of PPM with a scenario of no PPM. Costs were assessed in 2005 $US for public and private providers, patients and patient attendants. Sources of data included expenditure records, medical records, interviews with staff and patient surveys. Effectiveness was measured as the number of cases successfully treated.
  
  
  RESULTS
  When PPM was implemented, total provider costs increased in proportion to the number of successfully treated TB cases. The average cost per patient treated from the provider perspective when PPM was implemented was stable, at US$69, in the intensified phase compared with US$71 pre-PPM. PPM resulted in the shift of an estimated 7200 patients from non-DOTS to DOTS treatment over 5 years. PPM implementation substantially reduced costs to patients, such that the average societal cost per patient successfully treated fell from US$154 to US$132 in the 4 years following the initiation of PPM.
  
  
  CONCLUSIONS
  Implementation of PPM on a large scale in an urban setting can be cost-effective, and considerably reduces the financial burden of TB for patients.
authors.affiliation: Stop TB Department, World Health Organization, Geneva, Switzerland. pantojaa@who.int
authors.forename: A
authors.initials: A
authors.lastname: Pantoja
authors.forename: K
authors.initials: K
authors.lastname: Lönnroth
authors.forename: S S
authors.initials: SS
authors.lastname: Lal
authors.forename: L S
authors.initials: LS
authors.lastname: Chauhan
authors.forename: M
authors.initials: M
authors.lastname: Uplekar
authors.forename: M R
authors.initials: MR
authors.lastname: Padma
authors.forename: K P
authors.initials: KP
authors.lastname: Unnikrishnan
authors.forename: J
authors.initials: J
authors.lastname: Rajesh
authors.forename: P
authors.initials: P
authors.lastname: Kumar
authors.forename: S
authors.initials: S
authors.lastname: Sahu
authors.forename: F
authors.initials: F
authors.lastname: Wares
authors.forename: K
authors.initials: K
authors.lastname: Floyd
mesh_terms: D000995:Antitubercular Agents / Q000191:economics / Q000627:therapeutic use; D003140:Communicable Disease Control / Q000191:economics* / Q000458:organization & administration*; D003365:Costs and Cost Analysis; D023801:Directly Observed Therapy / Q000191:economics; D006801:Humans; D007194:India / Q000453:epidemiology; D009313:National Health Programs / Q000191:economics; D015397:Program Evaluation / Q000191:economics; D055818:Public-Private Sector Partnerships / Q000191:economics*; D011795:Surveys and Questionnaires; D014376:Tuberculosis / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D000995:Antitubercular Agents