title: An analysis of the costs and treatment success of collaborative arrangements among public and private providers for tuberculosis control in Indonesia.
abstract: OBJECTIVE
  To identify the cost-effectiveness of collaborative arrangements among public and private providers to employ the Directly Observed Treatment short-course (DOTS) strategy for tuberculosis (TB) control in Indonesia.
  
  
  METHODS
  Three strategies were assessed: hospital out-patient diagnosis with referral to public health centres (PHCs) for treatment, hospital out-patient diagnosis and treatment, and private practitioner referral of suspects to PHCs. The outcome was the number of sputum smear positive TB cases successfully treated. Costs include direct costs to providers and patients. Uncertainty analysis was done for both costs and effectiveness data.
  
  
  RESULTS
  The average cost per case successfully treated ranged from US$169 to $567 for different strategies. The cost per additional case successfully treated incremental to existing TB programmes ranged from US$152 to $982. In three of four provinces assessed, there was a clearly preferred strategy or strategies, although the preferred strategy differed by province; in one province a preferred strategy could not be identified.
  
  
  CONCLUSIONS
  All strategies increased TB case finding, although attribution is tentative because of the study design. Neither collaboration among private practitioners nor among hospitals is clearly preferred based on cost-effectiveness. For hospitals, this study suggests that having hospitals refer patients to health centres is preferable over hospitals administering treatment.
authors.affiliation: bjohns@jhsph.edu
authors.forename: Benjamin
authors.initials: B
authors.lastname: Johns
authors.forename: Ari
authors.initials: A
authors.lastname: Probandari
authors.forename: Yodi
authors.initials: Y
authors.lastname: Mahendradhata
authors.forename: Riris Andono
authors.initials: RA
authors.lastname: Ahmad
mesh_terms: D003299:Cooperative Behavior; D003362:Cost-Benefit Analysis; D023801:Directly Observed Therapy / Q000191:economics*; D006268:Health Facilities; D006801:Humans; D007214:Indonesia; D007407:Interviews as Topic; D017063:Outcome Assessment, Health Care; D055818:Public-Private Sector Partnerships; D012017:Referral and Consultation; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy*