Cost-Effectiveness of Public-Private Mixed Models in National Tuberculosis Program in Ho Chi Minh City, Vietnam

Abstract

Public-private mixed system in Tuberculosis program is internationally recommended by World Health Organization 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, 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 conventional model from a health system perspective under Vietnamese National TB Program in Ho Chi Minh City, Vietnam. Using activity-based costing method, costs were measured and estimated including financial and economic costs, excluding 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 the detection rates of all type of TB were 41.71% and 22.49%; of newly infected TB were 98.41% and 50.9% in PPM and the previous TB system, respectively. Total cost per life-year gained in PPM and in the previous TB system were around 11.89 USD and 9.33 USD, respectively. Incremental cost-effectiveness ratio 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 5.4488 (at the 2.5% percentile) to 5.4547 (at the percentile 97.5%). TB program in Ho Chi Minh City was cost effective, and PPM implemented lead to more cost effective. The first model of PPM is strongly proven that it should be sustained, or even expanded because of the obvious improved effectiveness. PPM was more cost respecting with more effective.