Cost-effectiveness analysis of public-private mixed models in national tuberculosis program in Ho Chi Minh City, Vietnam

Abstract

Public-private mixed system (PPM) in Tuberculosis (TB) program is internationally recommended by WHO to increase cooperation between public and private sector for effectively providing TB treatment. Although clinical benefits of PPM are apparent, the economic impacts of PPM are still unclear compared with the conventional system (previous TB system), in which only public health system provided TB treatments following DOTS. This study aims to measure the cost-effectiveness of TB treatment and incremental cost-effectiveness in the PPM models compared to the previous TB system from a health system perspective under Vietnamese National TB Program (NTP) in Ho Chi Minh City, Vietnam. Using activity-based costing method, costs were included financial and economic costs, excluded any costs related to patients. Effectiveness of TB program was measure through detection rate, successful treatment, and life-years gained. All data were collected for the year 2011, using USD in 2011. This study found that PPM was significantly increasing detection rates of all type of TB from 22.49% to 41.71%, of newly infected TB were from 40.52% to 98.41%; reducing total cost per life-year gained from 17.75 USD to 11.89 USD. Incremental cost-effectiveness ratio (ICER) of PPM implemented was around 5.4515 USD per life-year gained. One-way sensitivity analysis and Probabilistic sensitivity analysis proved robustness of these results on ICER which can be variable from 0.3 USD (at 10%) to 15.3 USD (at 90%). Cost effectiveness acceptability analysis showed that the PPM system will meet 100% being cost effective if the willingness to pay is at least 704 USD. TB program in Ho Chi Minh City was cost effective, and PPM implemented lead to more cost effective. Particularly, the model 1 – “referring model” of PPM, in which TB suspects were screened in contractors, and then referred to the NTP system for detecting and treating, was strongly proven that it should be sustained, or even expanded because of the obvious improved effectiveness. PPM was more cost respecting with more effective.