Costs of a successful public-private partnership for TB control in an urban setting in Nepal

The approach to costing took a comprehensive view, with inclusion of costs not only incurred by health facilities but also social costs borne by patients and their escorts. Semi-structured questionnaires and guided interviews were used to collect start-up and recurrent costs for the scheme.Overall costs for treating a TB patient under the PPP scheme averaged US$89.60. Start-up costs per patient represented 12% of the total budget. Half of recurrent costs were incurred by patients and their escorts, with institutional costs representing most of the rest. Female patients tended to spend more and patients referred from the private sector had the highest reported costs.Treating TB patients in the PPP scheme had a low additional cost, while doubling the case notification rate and maintaining a high success rate. Costs incurred by patients and their escorts were the largest contributors to the overall total. This suggests a focus for follow-up studies and for cost-minimisation strategies.Tuberculosis is a leading cause of death worldwide [1] and, although the incidence rate is higher in many African countries, South Asia is the worst affected region in terms of absolute numbers [2]. The internationally recommended DOTS strategy [3,4] has been successfully implemented in the public sector by many National Tuberculosis Programmes (NTPs), but in the private sector the quality of care is generally very poor [5-7] This is a cause for concern since the private sector is a major provider of TB care in South Asia, particularly in urban centres [8]. There is currently considerable international interest in involving private practitioners (PPs) in TB control [9-11]. However, there is little documented evidence of the costs of such partnerships [12].In Nepal, over 14,000 new cases of smear positive (i.e. infectious) tuberculosis are notified each year [13], and it has been estimated that in urban areas 50% of TB patients were (poorly) managed in the private sector [14,15]. Furthermo