The Incremental Cost-Effectiveness of Engaging Private Practitioners to Refer Tuberculosis Suspects to DOTS Services in Jogjakarta, Indonesia
Yodi Mahendradhataa, Ari Natalia Probandarib c d e f g h i j, Riris Andono Ahmadb c d e f g h i j, Adi Utarinib c d e f g h i j, Laksono Trisnantorob c d e f g h i j, Lars Hjalmar Lindholmb c d e f g h i j, Marieke J. van der Werfb c d e f g h i j k, Michael Kimerlingb c d e f g h i j, Marleen Boelaertb c d e f g h i j, Benjamin Johnsb c d e f g h i j, Patrick Van der Stuyftb c d e f g h i j
- aDepartment of Public Health, Faculty of Medicine, Gadjah Mada University, Jogjakarta, Indonesia. yodi_mahendradhata@yahoo.co.uk
- bDepartment of Public Health, Faculty of Medicine, Gadjah Mada University, Jogjakarta, Indonesia
- cCentre for Health Service Management, Faculty of Medicine, Gadjah Mada University, Jogjakarta, Indonesia
- dEpidemiology and Disease Control Unit, Public Health Department, Institute of Tropical Medicine, Antwerp, Belgium
- eDepartment of Public Health, Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia
- fEpidemiology and Public Health Sciences, Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- gKNCV Tuberculosis Foundation, The Hague, The Netherlands
- hDepartment of Infectious Diseases, Tropical Medicine & AIDS, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, The Netherlands
- iGorgas TB Initiative, UAB School of Medicine, Division of Infectious Diseases, Birmingham, Alabama
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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.