Cost-effectiveness Analysis of Public and Public Private Mix Dots Treatment Centers in Nepal :|b a case study of Kathmandu Metropolitan City

Tuberculosis is one of the major public health problems in Nepal. About 45% of the population is infected with TB, out of which 60% are in economically active age group. A substantial number of TB cases (about 40-50%) are being treated by private sector. To manage this bulk of active TB patients properly, PPM-DOTS service seems to be more important. Since 1997, Nepal has been practicing public-private mix concept in tuberculosis control, basically after implementation of Directly Observed Treatment, Short Course (DOTS) stategy. This cost-effectiveness analysis was carried out in Kathmandu Metropolitan City form provider perspective. Two public and two public-private mix DOTS centers were selected for the study purpose. The evaluation period was first eight months of F/Y 2000/01.Data on providers' costs were collected from DOTS centers. Drug cost/laboratory reagent cost/equipment cost were obtained from National Tuberculosis Center. Treatment outcomes were collected from DOTS centers. The average cost per effectiveness in public DOTS centers was about US$ 110.6, while that was US$ 47.4 in PPM-DOTS centers. The results also show that capital cost of each DOTS center did not exceed more than 9.7% of total provider cost. But labor costs varied from 17-49%. In public DOTS centers the range of labor cost was 30-48%, while in PPM-DOTS centers it was 17-24% of total provider cost. The observed treatment outcome in PPM-DOTS centers seems to be effective. It was either approaching or better than the standard set by WHO/NTC, while that of public DOTS centers was far below from the target. In conclusion, PPM DOTS centers seem to be more cost-effective than public DOTS centers. In urban area, PPM-DOTS centers could help reduce tuberculosis related morbidity and mortality and hence to achieve National Tuberculosis Center's (NTC) objective. NTC could increase the efficiency of its activities with private providers. Thus, this study could suggest the wider implementation of PPM-DOTS service for tuberculosis in urban area of Nepal.