Volume 82, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



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.


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  1. WHO, 2006. Engaging All Health Care Providers in TB Control. Geneva: WHO.
  2. Uplekar M, Pathania V, Raviglione M, , 2001. Private practitioners and public health: weak links in tuberculosis control. Lancet 9285: 912916.[Crossref]
  3. WHO, 2006. The Stop TB Strategy: Building on and Enhancing DOTS to Meet the TB-Related Millennium Development Goals. Geneva: WHO.
  4. Mahendradhata Y, Lambert ML, Boelaert M, Van der Stuyft P, , 2007. Engaging the private sector for tuberculosis control: much advocacy on a meagre evidence base. Trop Med Int Health 12: 315316.[Crossref]
  5. Uplekar M, Lönnroth K, , 2007. MDR and XDR: price of delaying engagement with all care providers for control of TB and TB/HIV. Trop Med Int Health 12: 473474.[Crossref]
  6. Dewan PK, Lai SS, Lonnroth K, Wares F, Uplekar M, Sahu S, Granich R, Chauhan LS, , 2006. Improving tuberculosis control through public private collaboration in India: literature review. BMJ 7541: 574578.[Crossref]
  7. Floyd K, Arora VK, Murthy KJR, Lonnroth K, Singla N, Akbar Y, Zignol M, Uplekar M, , 2006. Cost and cost-effectiveness of PPM-DOTS for tuberculosis control: evidence from India. Bull World Health Organ 8: 437455.[Crossref]
  8. Sinanovic E, Kumaranayake L, , 2006. Financing and cost-effectiveness analysis of public-private partnerships: provision of tuberculosis treatment in South Africa. Cost Eff Resour Alloc 4: 11.[Crossref]
  9. Karki DK, Mirzoev TN, Green AT, Newell JN, Baral SC, , 2007. Costs of a successful public-private partnership for TB control in an urban setting in Nepal. BMC Public Health 7: 84.[Crossref]
  10. WHO, 2008. Global Tuberculosis Control: Surveillance, Planning and Financing: WHO Report 2008. Geneva: WHO.
  11. BPS-statistics Indonesia, 2007. Health Statistics 2004. Jakarta: BPS-statistics Indonesia.
  12. NIHRD, 2005. The Tuberculosis Prevalence Survey in Indonesia 2004. Jakarta: NIHRD.
  13. Irawati SR, Basri C, Arias MS, Prihatini S, Rintiswati N, Voskens J, Kimerling ME, , 2007. Hospital DOTS linkage in Indonesia: a model for DOTS expansion into government and private hospitals. Int J Tuberc Lung Dis 11: 3339.
  14. Mahendradhata Y, Utarini A, Lazuardi U, Boelaert M, Van der Stuyft P, , 2007. Private practitioners and tuberculosis case detection in Jogjakarta, Indonesia: actual role and potential. Trop Med Int Health 12: 12181224.[Crossref]
  15. MOH-Stop TB Partnership, 2007. Report of the joint external TB monitoring mission: Indonesia, April 16–27, 2007.
  16. Utarini A, Mahendradhata Y, Syahrizal B, , 2006. Fidelis project report summary: scaling up public private mix for TB control in Yogyakarta and Bali provinces. Jogjakarta: GMU Center for Health Service Management.
  17. Drummond M, Sculpher M, Torrance G, O'Brien B, Stoddart G, , 2005. Methods for the Economic Evaluation of Health Care Programmes. Third edition. Oxford, UK: Oxford University Press.
  18. Briggs AH, O'Brien BJ, Blackhouse G, , 2002. Thinking outside the box: recent advances in the analysis and presentation of uncertainty in cost-effectiveness studies. Annu Rev Public Health 23: 377401.[Crossref]
  19. Fenwick E, O'Brien BJ, Briggs A, , 2004. Cost-effectiveness acceptability curves–facts, fallacies and frequently asked questions.Health Econ 13: 405415.[Crossref]
  20. Quy HT, Lan NT, Lonnroth K, Buu TN, Dieu TT, Hai LT, , 2003. Public-private mix for improved TB control in Ho Chi Minh City, Vietnam: an assessment of its impact on case detection. Int J Tuberc Lung Dis 7: 464471.
  21. Newell JN, Pande SB, Baral SC, Bam DS, Malla P, , 2004. Control of tuberculosis in an urban setting in Nepal: public-private partnership. Bull World Health Organ 82: 9298.
  22. Krishnan A, Kapoor SK, , 2006. Involvement of private practitioners in tuberculosis control in Ballabgarh, Northern India. Int J Tuberc Lung Dis 10: 264269.
  23. Lonnroth K, Aung T, Maung W, Kluge H, Uplekar M, , 2007. Social franchising of TB care through private GPs in Myanmar: an assessment of treatment results, access, equity and financial protection. Health Policy Plan 22: 156166.[Crossref]
  24. Lambert ML, Delgado R, Michaux G, Vols A, Speybroeck N, Van der Stuyft P, , 2005. Collaboration between private pharmacies and national tuberculosis programme: an intervention in Bolivia. Trop Med Int Health 10: 246250.[Crossref]
  25. Kelkar-Khambate A, Kielmann K, Pawar S, Porter J, Inamdar V, Datye A, Rangan S, , 2008. India's Revised National Tuberculosis Control Programme: looking beyond detection and cure. Int J Tuberc Lung Dis 12: 8792.
  26. Lonnroth K, Uplekar M, Arora V, Juvekar S, Lan NT, Mwaniki D, Pathania V, , 2004. Public-private mix for DOTS implementation: what makes it work? Bull World Health Organ 8: 580586.
  27. Newell JN, Pande SB, Baral SC, Bam DS, Malla P, , 2005. Leadership, management and technical lessons learnt from a successful public-private partnership for TB control in Nepal. Int J Tuberc Lung Dis 9: 10131017.
  28. Yassin MA, Cuevas LE, , 2003. How many sputum smears are necessary for case finding in pulmonary tuberculosis? Trop Med Int Health 8: 927932.[Crossref]
  29. Statistic Indonesia BPS, 2008. Improving data for decentralized planning. Available at: http://www.datastatistik-indonesia.com. Accessed May 2008.
  30. Dye C, Maher D, Weil D, Espinal M, Raviglione M, , 2006. Targets for global tuberculosis control. Int J Tuberc Lung Dis 10: 460462.
  31. Ferroussier O, Kumar MK, Dewan PK, Nair PK, Sahu S, Wares F, Laserson K, Wells C, Granich R, Chauhan LS, , 2007. Cost and cost-effectiveness of a public-private mix project in Kannur District, Kerala, India, 2001–2002. Int J Tuberc Lung Dis 11: 755761.

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  • Received : 03 Aug 2009
  • Accepted : 27 Feb 2010

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