The Incremental Cost-Effectiveness of Engaging Private Practitioners to Refer Tuberculosis Suspects to DOTS Services in Jogjakarta, Indonesia

Mahendradhata, Yodi; Probandari, Ari; Ahmad, Riris Andono; Trisnantoro, Laksono; Lindholm, Lars; Werf, Marieke J. van der; Kimerling, Michael E.; Boelaert, Marleen; Johns, Benjamin; Stuyft, Patrick Van der

doi:10.4269/ajtmh.2010.09-0447

Cited by 21 publications

(16 citation statements)

References 15 publications

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“…Although Ahmad et al (2009) concluded that actively finding cases would provide the best outcomes, that strategy may be less cost-effective than other strategies, including involvement of the private sector in the DOTS strategy. Mahendradhata et al (2010) conducted a study to evaluate the incremental cost-effectiveness of such an initiative in Yogyakarta province where private practitioners were engaged to refer patient suspected of TB to a healthcare centre for DOTS treatment. They concluded that this strategy could be cost-effective given a wellfunctioning DOTS programme.…”

Section: Discussionmentioning

confidence: 99%

Patient delay determinants for patients with suspected tuberculosis in Yogyakarta province, Indonesia

Lock¹,

Ahmad²,

Ruiter³

et al. 2011

Tropical Med Int Health

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Summaryobjectives Indonesia has a high incidence of tuberculosis (TB), despite the successful introduction of the directly observed treatment short-course strategy (DOTS strategy). DOTS depends on passive case finding. It is therefore important to identify determinants of patient delay and reasons for visiting a DOTS healthcare provider when seeking care. The aim of this study was to assess these determinants in TB suspects (coughing for at least 2 weeks).methods Cross-sectional data were gathered with a structured questionnaire in which psychosocial determinants were based on an extended version of the theory of planned behaviour (TPB). The study was conducted in five governmental lung clinics of Yogyakarta province. In total, 194 TB suspects that registered at the lung clinics were interviewed.results The median patient delay was 14 days (range 0-145). Ordinal regression analyses showed that visiting a private healthcare provider when first seeking health care, reporting travel distance ⁄ travel time as reason for choosing a certain healthcare provider when first seeking health care, discussing the symptoms with family and a reported short travel time, but no factors of TPB, were significantly associated with a shorter patient delay. An important factor negatively associated with visiting a DOTS clinic was the reported travel time.conclusion Accessibility of the healthcare provider was the main determinant of patient delay, but the role of psychosocial factors cannot be fully excluded. Urban and suburban areas have relatively good access to (private) health care, hence the short delay. Thus, future studies should be focussed on extending the DOTS strategy to the private sector.keywords tuberculosis, patient delay, healthcare seeking behaviour, Indonesia, theory of planned behaviour, directly observed treatment short-course strategy

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Section: Discussionmentioning

confidence: 99%

Patient delay determinants for patients with suspected tuberculosis in Yogyakarta province, Indonesia

Lock¹,

Ahmad²,

Ruiter³

et al. 2011

Tropical Med Int Health

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“…According to a WHO report, global grants for TB control have been increasing Financial support and material supply and technical resources 17 IND-1, 2 103,104 This may be the result of successful TB control activities and a stable reduction of TB prevalence, but most evaluations have argued that current funding is insufficient to sustain the scale-up of PPM in the long term and that more investment is urgently needed. 34,48,66,74 Therefore, the analysis of cost-effectiveness and expenditure reduction is an increasing requirement. Incentives, although not an essential condition, are always thought to be a useful approach to improve PPM participation and the service performance of physicians.…”

Section: Interpretation and Summarymentioning

confidence: 99%

Public–private mix for tuberculosis care and control: a systematic review

Lei

Liu

Escobar

et al. 2015

International Journal of Infectious Diseases

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PPM is a promising strategy to strengthen global TB care and control, but is affected by contextual characteristics in different areas. The scaling-up of PPM should contain essential commonalities, particularly substantial financial support and continuous material input. Additionally, it is important to improve program governance and training for the health providers involved, through integrated collaborative mechanisms.

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“…For example, while many of the articles and abstracts described the potential returns of engaging retail drug outlets, none of the 12 full-text articles described the necessary inputs in terms of cost. TB programs that may need to prioritize among various PPM interventions must have an understanding of the estimated costs and cost effectiveness of each intervention [24, 25],. Such estimates, if modeled from pilot or small-scale initiatives, would allow TB programs to use a set amount of funding to determine which intervention would return the greatest output in terms of presumptive TB cases referred and ultimately confirmed.…”

Section: Discussionmentioning

confidence: 99%

Engagement of the private pharmaceutical sector for TB control: rhetoric or reality?

Konduri

Emily

Rutta

2017

J of Pharm Policy and Pract

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BackgroundPrivate-sector retail drug outlets are often the first point of contact for common health ailments, including tuberculosis (TB). Systematic reviews on public-private mix (PPM) interventions for TB did not perform in-depth reviews specifically on engaging retail drug outlets and related stakeholders in the pharmaceutical sector. Our objective was to better understand the extent to which the World Health Organization’s (WHO) recommendation on engaging retail drug outlets has been translated into programmatic policy, strategy, and intervention in low- and middle-income countries.MethodsThe study included a content analysis of global-level documents from WHO and the Stop TB Partnership in five phases. A country-level content analysis from four data sources was performed. Global-level findings were tabulated based on key messages related to engaging retail drug outlets. Country-level findings were analyzed based on four factors and tabulated. National strategic plans for TB control from 14 countries with varying TB burdens and a strong private sector were reviewed.Results33 global-level documents and 77 full-text articles and Union World Lung Health conference abstracts were included for review. Based on experience of engaging retail drug outlets that has emerged since the mid-2000s, in 2011 WHO and the International Pharmaceutical Federation released a joint statement on promoting the engagement of national pharmacy associations in partnership with national TB programs. Only two of 14 countries’ national strategic plans had explicit statements on the need to engage their national pharmacy professional association. The success rate of referrals from retail drug outlets who visited an approved health facility for TB screening ranged from 48% in Vietnam to 86% in Myanmar. Coverage of retail drug outlets ranged from less than 5 to 9% of the universe of retail drug outlets.ConclusionsFor WHO’s End TB Strategy to be successful, scaling up retail drug outlets to increase national coverage, at least in countries with a thriving private sector, will be instrumental in accelerating the early detection and referral of the 3 million missing TB cases. The proposed PPM pharmacy model is applicable not only for TB control but also to tackle the antimicrobial resistance crisis in these countries.Electronic supplementary materialThe online version of this article (doi:10.1186/s40545-016-0093-3) contains supplementary material, which is available to authorized users.

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The Incremental Cost-Effectiveness of Engaging Private Practitioners to Refer Tuberculosis Suspects to DOTS Services in Jogjakarta, Indonesia

Cited by 21 publications

References 15 publications

Patient delay determinants for patients with suspected tuberculosis in Yogyakarta province, Indonesia

Patient delay determinants for patients with suspected tuberculosis in Yogyakarta province, Indonesia

Public–private mix for tuberculosis care and control: a systematic review

Engagement of the private pharmaceutical sector for TB control: rhetoric or reality?

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