Cost and cost-effectiveness of a public-private mix project in Kannur District, Kerala, India, 2001-2002.

BACKGROUND Little is known yet about the cost-effectiveness of public-private mix (PPM) collaborations for the delivery of tuberculosis (TB) diagnostic and treatment services. DESIGN We evaluated the cost and cost-effectiveness of a PPM project targeting private laboratories in Kannur district, India, from the perspective of the Revised National TB Control Programme (RNTCP). We estimated the cost per provider recruited and retained, the cost per additional patient notified under various effectiveness scenarios and the cost per additional patient successfully treated. Intervention cost data were abstracted from RNTCP records. Treatment costs were estimated based on RNTCP case management protocols. RESULTS The annual total estimated cost of the project was US$8712-$11611. The cost per private provider recruited varied between US$22 and US$54. The cost per additional pulmonary TB patient privately diagnosed was US$14-$18. In the most conservative scenario, the cost per additional patient notified was US$29-$36. The cost per new acid-fast bacilli-positive patient successfully treated was US$47-$51. Higher notification rates would improve cost-effectiveness. CONCLUSIONS Comparisons with public sector diagnostic costs are required to determine if this intervention remains economically attractive to the public health care system at different activity levels and to determine the supplemental resources needed if scale-up is pursued.