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The incremental cost-effectiveness of engaging private practitioners to refer tuberculosis suspects to DOTS services in Jogjakarta, Indonesia

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Abstract
We aimed to evaluate the incremental cost-effectiveness of engaging private practitioners (PPs) to refer tuberculosis (TB) suspects to public health centers in Jogjakarta, Indonesia. Effectiveness was assessed for TB suspects notified between May 2004 and April 2005. Private practitioners referred 1,064 TB suspects, of which 57.5% failed to reach a health center. The smear-positive rate among patients reaching a health center was 61.8%. Two hundred eighty (280) out of a total of 1,306 (21.4%) new smear-positive cases were enrolled through the PPs strategy. The incremental cost-effectiveness ratio per smear-positive case successfully treated for the PPs strategy was US$351.66 (95% CI 322.84-601.33). On the basis of an acceptability curve using the National TB control program's willingness-to-pay threshold (US$448.61), we estimate the probability that the PPs strategy is cost-effective at 66.8%. The strategy of engaging PPs was incrementally cost-effective, although under specific conditions, most importantly a well-functioning public directly observed treatment, short-course (DOTS) program.
Keywords
INDIA, TB CONTROL, PARTNERSHIP, NEPAL, MIX, COLLABORATION, CARE, PROGRAM

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Chicago
Mahendradhata, Y, A Probandari, RA Ahmad, A Utarini, L Trisnantoro, L Lindholm, MJ van der Werf, et al. 2010. “The Incremental Cost-effectiveness of Engaging Private Practitioners to Refer Tuberculosis Suspects to DOTS Services in Jogjakarta, Indonesia.” American Journal of Tropical Medicine and Hygiene 82 (6): 1131–1139.
APA
Mahendradhata, Y, Probandari, A., Ahmad, R., Utarini, A., Trisnantoro, L., Lindholm, L., van der Werf, M., et al. (2010). The incremental cost-effectiveness of engaging private practitioners to refer tuberculosis suspects to DOTS services in Jogjakarta, Indonesia. AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE, 82(6), 1131–1139.
Vancouver
1.
Mahendradhata Y, Probandari A, Ahmad R, Utarini A, Trisnantoro L, Lindholm L, et al. The incremental cost-effectiveness of engaging private practitioners to refer tuberculosis suspects to DOTS services in Jogjakarta, Indonesia. AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE. 2010;82(6):1131–9.
MLA
Mahendradhata, Y, A Probandari, RA Ahmad, et al. “The Incremental Cost-effectiveness of Engaging Private Practitioners to Refer Tuberculosis Suspects to DOTS Services in Jogjakarta, Indonesia.” AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE 82.6 (2010): 1131–1139. Print.
@article{1113908,
  abstract     = {We aimed to evaluate the incremental cost-effectiveness of engaging private practitioners (PPs) to refer tuberculosis (TB) suspects to public health centers in Jogjakarta, Indonesia. Effectiveness was assessed for TB suspects notified between May 2004 and April 2005. Private practitioners referred 1,064 TB suspects, of which 57.5\% failed to reach a health center. The smear-positive rate among patients reaching a health center was 61.8\%. Two hundred eighty (280) out of a total of 1,306 (21.4\%) new smear-positive cases were enrolled through the PPs strategy. The incremental cost-effectiveness ratio per smear-positive case successfully treated for the PPs strategy was US\$351.66 (95\% CI 322.84-601.33). On the basis of an acceptability curve using the National TB control program's willingness-to-pay threshold (US\$448.61), we estimate the probability that the PPs strategy is cost-effective at 66.8\%. The strategy of engaging PPs was incrementally cost-effective, although under specific conditions, most importantly a well-functioning public directly observed treatment, short-course (DOTS) program.},
  author       = {Mahendradhata, Y and Probandari, A and Ahmad, RA and Utarini, A and Trisnantoro, L and Lindholm, L and van der Werf, MJ and Kimerling, M and Boelaert, M and Johns, B and Van Der Stuyft, Patrick},
  issn         = {0002-9637},
  journal      = {AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE},
  keyword      = {INDIA,TB CONTROL,PARTNERSHIP,NEPAL,MIX,COLLABORATION,CARE,PROGRAM},
  language     = {eng},
  number       = {6},
  pages        = {1131--1139},
  title        = {The incremental cost-effectiveness of engaging private practitioners to refer tuberculosis suspects to DOTS services in Jogjakarta, Indonesia},
  url          = {http://dx.doi.org/10.4269/ajtmh.2010.09-0447},
  volume       = {82},
  year         = {2010},
}

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