Cost effectiveness of interventions using the tb dots strategy in public healthcare and private hospitals in depok, west java, indonesia

In 2016, the global Tuberculosis (TB) case notification rate was 77%, and 46.5% in Southeast Asia. During the last five years in Indonesia specifically, the rate has been 32–33%; however, in Depok City, it reached 58%. In Depok City, the private sector contributed 18.7% of the notified TB cases in 2016, though only 40% of its private hospitals were involved. However, the costs incurred by the private sector were higher. The aim of this study was to determine the cost effectiveness of implementing the DOTS (Directly Observed Treatment Shortcourse) strategy in private hospitals. A comparative study was carried out for six months, along with a retrospective cohort study between Public Health Centers (PHCs), DOTS hospitals, and non-DOTS hospitals, using 36 samples per group. The calculations of societal perspectives mentioned in Indonesian Rupiah (IDR) using micro-costing. The output was the success rate, which at the PHC hospital was 86.1%, at the DOTS hospital was 77.78%, and at the non-DOTS hospital was 63.89%. The addition of cost providers, especially human resources, at the PHCs and DOTS hospital increased their success rates. The societal cost of TB treatment in the PHCs was 42% that of the private hospital. The average cost-effectiveness ratio (ACER) showed that hospitals that carry out the DOTS strategy are more cost-effective than those that do not. To increase the TB treatment success rate by 1%, IDR 10,084,572 is needed in order to conduct a DOTS program intervention in a private hospital. An independent t-test showed that the cost effectiveness of societal perspectives on TB treatment was significantly different between the PHCs, the DOTS hospital, and the non-DOTS hospital.