Cost-Effectiveness of Public and Metropolitan Dots Centres in Kathmandu Metropolitan City, Nepal

Abstract

Tuberculosis (TB) is still a major cause of death worldwide. It is one of the major public health problems in Nepal. About 45 percent of the total populations are infected with TB, out of which 60 percents are adult and 70 percent of cases in the most economically productive age group. Though DOTS strategy being success in TB control, it is still a big challenges in urban area. This cost effectiveness analysis was carried out in Kathmandu Metropolitan city from provider prospective. Three from public (government health institution) and four from Metropolitan DOTS centers were selected for the study purpose. The public DOTS centers had microscopy and x-ray facility while Metropolitan DOTS centre had not. The study period was mid July 2005 to mid July 2006. Cost per effectiveness in public DOTS centers ranges from US$ 87 to US$ 197, while Metropolitan DOTS centers ranges from US$ 83 to US$ 116. The result showed that capital cost of each DOTS centre are less than 17 percent of total providers’ cost. But labor cost varied from 18 percent to 38 percent. In public DOTS centers, labor cost was 29 percent to 38.3 percent while in Metropolitan DOTS centre it was around 18 percent. In public DOTS center total providers’ cost found high per case treatment success because of its availability of diagnosis facility, infrastructure, staffing. In conclusion, Metropolitan DOTS centers seem more cost effective than public DOTS centre.