The incremental cost-effectiveness of engaging private practitioners to refer tuberculosis suspects to DOTS services in Jogjakarta, Indonesia

Y Mahendradhata, A Probandari, RA Ahmad, A Utarini, L Trisnantoro, L Lindholm, MJ Van der Werf, M Kimerling, M Boelaert, B Johns, P Van der Stuyft

    Research output: Contribution to journalA1: Web of Science-article

    Abstract

    We aimed to evaluate the incremental cost-effectiveness of engaging private practitioners (PPs) to refer tuberculosis (TB) suspects to public health centers in Jogjakarta, Indonesia. Effectiveness was assessed for TB suspects notified between May 2004 and April 2005. Private practitioners referred 1,064 TB suspects, of which 57.5% failed to reach a health center. The smear-positive rate among patients reaching a health center was 61.8%. Two hundred eighty (280) out of a total of 1,306 (21.4%) new smear-positive cases were enrolled through the PPs strategy. The incremental cost-effectiveness ratio per smear-positive case successfully treated for the PPs strategy was US$351.66 (95% CI 322.84-601.33). On the basis of an acceptability curve using the National TB control program's willingness-to-pay threshold (US$448.61), we estimate the probability that the PPs strategy is cost-effective at 66.8%. The strategy of engaging PPs was incrementally cost-effective, although under specific conditions, most importantly a well-functioning public directly observed treatment, short-course (DOTS) program
    Original languageEnglish
    JournalAmerican Journal of Tropical Medicine and Hygiene
    Volume82
    Issue number6
    Pages (from-to)1131-1139
    Number of pages9
    ISSN0002-9637
    DOIs
    Publication statusPublished - 2010

    Keywords

    • B780-tropical-medicine
    • Bacterial diseases
    • Tuberculosis
    • Mycobacterium tuberculosis
    • Treatment
    • DOTS
    • Referral
    • Private sector
    • Private health care
    • Public health services
    • Cost-effectiveness
    • Smear-positive
    • Acceptability
    • Willingness-to-pay
    • Thresholds
    • Indonesia
    • Asia-Southeast

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