Engaging with the Private Healthcare Sector for the Control of Tuberculosis in India: Cost and Cost-effectiveness

Overview

Journal BMJ Glob Health

Specialty Public Health

Date 2021 Oct 6

PMID 34610905

Citations 8

Authors

Nimalan Arinaminpathy

Arindam Nandi

Shibu Vijayan

Nita Jha

Sreenivas A Nair

Sameer Kumta

Puneet Dewan

Kiran Rade

Bhavin Vadera

Raghuram Rao

Kuldeep S Sachdeva

Affiliations

Soon will be listed here.

Abstract

Background: The control of tuberculosis (TB) in India is complicated by the presence of a large, disorganised private sector where most patients first seek care. Following pilots in Mumbai and Patna (two major cities in India), an initiative known as the 'Public-Private Interface Agency' (PPIA) is now being expanded across the country. We aimed to estimate the cost-effectiveness of scaling up PPIA operations, in line with India's National Strategic Plan for TB control.

Methods: Focusing on Mumbai and Patna, we collected cost data from implementing organisations in both cities and combined this data with models of TB transmission dynamics. Estimating the cost per disability adjusted life years (DALY) averted between 2014 (the start of PPIA scale-up) and 2025, we assessed cost-effectiveness using two willingness-to-pay approaches: a WHO-CHOICE threshold based on per-capita economic productivity, and a more stringent threshold incorporating opportunity costs in the health system.

Findings: A PPIA scaled up to ultimately reach 50% of privately treated TB patients in Mumbai and Patna would cost, respectively, US$228 (95% uncertainty interval (UI): 159 to 320) per DALY averted and US$564 (95% uncertainty interval (UI): 409 to 775) per DALY averted. In Mumbai, the PPIA would be cost-effective relative to all thresholds considered. In Patna, if focusing on adherence support, rather than on improved diagnosis, the PPIA would be cost-effective relative to all thresholds considered. These differences between sites arise from variations in the burden of drug resistance: among the services of a PPIA, improved diagnosis (including rapid tests with genotypic drug sensitivity testing) has greatest value in settings such as Mumbai, with a high burden of drug-resistant TB.

Conclusions: To accelerate decline in TB incidence, it is critical first to engage effectively with the private sector in India. Mechanisms such as the PPIA offer cost-effective ways of doing so, particularly when tailored to local settings.

Citing Articles

Engaging private providers to enhance tuberculosis detection and notification: evidence from TB REACH-Supported projects.

Rahman M, Wells W, Ramis O, Kamineni V, Bakker M, Matiku S BMC Public Health. 2025; 25(1):665.

PMID: 39966879 PMC: 11837381. DOI: 10.1186/s12889-025-21806-4.

Cost of TB care and equity in distribution of catastrophic TB care costs across income quintiles in India.

Jeyashree K, Thangaraj J, Shanmugasundaram D, Giridharan S, Pandey S, Shanmugasundaram P Glob Health Res Policy. 2024; 9(1):51.

PMID: 39648213 PMC: 11626761. DOI: 10.1186/s41256-024-00392-9.

Case fatality among people with drug-susceptible TB enrolled in a private health sector TB treatment support program in Bihar, India during the first year of the COVID-19 pandemic.

Faust L, Ranjan A, Jha N, Pai M, Huddart S PLOS Glob Public Health. 2024; 4(9):e0003277.

PMID: 39264895 PMC: 11392330. DOI: 10.1371/journal.pgph.0003277.

Rethinking Tuberculosis Morbidity Quantification: A Systematic Review and Critical Appraisal of TB Disability Weights in Cost-Effectiveness Analyses.

Tomeny E, Hampton T, Tran P, Rosu L, Phiri M, Haigh K Pharmacoeconomics. 2024; 42(11):1209-1236.

PMID: 39110388 PMC: 11499453. DOI: 10.1007/s40273-024-01410-x.

Participation of private providers in the National TB Programme in South India.

Meundi A, Richardus J Public Health Action. 2023; 13(4):142-147.

PMID: 38077727 PMC: 10703141. DOI: 10.5588/pha.23.0032.

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