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. 2024 Jun 21;14(1):44.
doi: 10.1186/s13561-024-00518-2.

Estimating the budget impact of a Tuberculosis strategic purchasing pilot study in Medan, Indonesia (2018-2019)

Sarah Saragih  1 , Firdaus Hafidz  2 , Aditia Nugroho  1 , Laurel Hatt  3 , Meghan O'Connell  3 , Agnes Caroline  4 , Cheryl Cashin  3 , Syed Imran  4 , Yuli Farianti  5 , Ackhmad Afflazier  5 , Tiara Pakasi  5 , Nurul Badriyah  5
Affiliations

Estimating the budget impact of a Tuberculosis strategic purchasing pilot study in Medan, Indonesia (2018-2019)

Sarah Saragih et al. Health Econ Rev. .

Abstract

Background: Indonesia has the world's second-highest tuberculosis (TB) burden, with 969,000 annual TB infections. In 2017, Indonesia faced significant challenges in TB care, with 18% of cases missed, 29% of diagnosed cases unreported, and 55.4% of positive results not notified. The government is exploring a new approach called "strategic purchasing" to improve TB detection and treatment rates and offer cost-effective service delivery.

Objectives: We aimed to analyze the financial impact of implementing a TB purchasing pilot in the city of Medan and assess the project's affordability and value for money.

Methods: We developed a budget impact model to estimate the cost-effectiveness of using strategic purchasing to improve TB reporting and treatment success rates. We used using data from Medan's budget impact model and the Ministry of Health's guidelines to predict the total cost and the cost per patient.

Results: The model showed that strategic purchasing would improve TB reporting by 63% and successful treatments by 64%. While this would lead to a rise in total spending on TB care by 60%, the cost per patient would decrease by 3%. This is because more care would be provided in primary healthcare settings, which are more cost-effective than hospitals.

Conclusions: While strategic purchasing may increase overall spending, it could improve TB care in Indonesia by identifying more cases, treating them more effectively, and reducing the cost per patient. This could potentially lead to long-term cost savings and improved health outcomes.

Keywords: Budget impact; Indonesia; National health insurance; Strategic purchasing; Tuberculosis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Sensitivity analysis (Cost per patient, varying reductions in vertical referrals) (Minimal scenario: 19% and 8% reduction of upward referrals from private and public PHCs, respectively; Medium scenario: 37% and 15% reduction of upward referrals from private and public PHCs, respectively; Maximal scenario: 56% and 23.1% reduction of upward referrals from private and public PHCs.). *US$1 = 14,212 rupiah (Bank Indonesia, June 28, 2019)
Fig. 2
Fig. 2
Sensitivity analysis (Cost per patient, varying rates of TB notifications) (Minimal scenario: 30%, 3%, and 19% increase in TB confirmed notification at private PHC, public PHC, and hospitals, respectively; Medium scenario: 60.7%, 6.7%, and 38% increase in TB confirmed notification at private PHC, public PHC, and hospitals; Maximum scenario: 91%, 10%, and 57% increase in TB confirmed notification at private PHC, public PHC, and hospitals.). *US$1 = 14,212 rupiah (Bank Indonesia, June 28, 2019)
Fig. 3
Fig. 3
Sensitivity analysis (Cost per patient, varying rates of successful TB treatment) (Minimal scenario: 2.2% increase of successful treatment at private PHC and hospitals, and 1.8% increase of successful treatment at public PHCs; Medium scenario: 4.3% increase of successful treatment at private PHC and hospitals, and 3.5% increase of successful treatment at public PHCs; Maximal scenario: 6.5% increase of successful treatment at private PHC and hospitals, and 5.3% increase of successful treatment at public PHCs.). *US$1 = 14,212 rupiah (Bank Indonesia, June 28, 2019)
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