Economic Evaluation of a Public–Private Mix TB Project in Tamil Nadu, India

Abstract

Objective: This study aims to assess the effectiveness and cost-effectiveness of a public–private mix (PPM) project with private sector as sole provider of services in an urban area under India’s Tuberculosis (TB) Control Programme in Tamil Nadu. Methods: Directly observed treatment, short-course (DOTS) was provided exclusively by a non-governmental organization (NGO) in one area which was compared with another area served by public sector. Data on cost and effectiveness were collected from records and interviews of patients. Cost and effectiveness of non-DOTS treatment was based on previous literature and market rates. Costs for 2011 in US$ were assessed for PPM and non-PPM areas with both public provider and societal perspective. Effectiveness was measured as proportion of cases successfully treated. Results: Service delivery through private sector alone had limited success in drawing patients to DOTS and majority of TB patients received non-DOTS in the area managed by the NGO. From the public provider perspective, cost per patient treated was US$19 in non-PPM and US$22 in PPM DOTS. From societal perspective, these costs were US$142, US$192 and US$204 for non-PPM DOTS, PPM DOTS and non-DOTS strategies, respectively. Incremental cost-effectiveness analysis found PPM DOTS to be more cost-effective compared to non-DOTS but less cost-effective than non-PPM DOTS. Conclusion: In rapidly growing urban areas with lack of public sector infrastructure, engaging private sector is a short-term measure to improve effectiveness of the TB Control Programme. Developing public sector infrastructure is key to long-term success especially in countries where private sector is largely unregulated.