Cost analysis of smear microscopy and the Xpert assay for tuberculosis diagnosis: average turnaround time

Abstract

Introduction: Rapid and accurate tuberculosis detection is critical for improving patient diagnosis and decreasing tuberculosis transmission. Molecular assays can significantly increase laboratory costs; therefore, the average time and economic impact should be evaluated before implementing a new technology. The aim of this study was to evaluate the cost and average turnaround time of smear microscopy and Xpert assay at a university hospital. Methods: The turnaround time and cost of the laboratory diagnosis of tuberculosis were calculated based on the mean cost and activity based costing (ABC). Results: The average turnaround time for smear microscopy was 16.6 hours while that for Xpert was 24.1 hours. The Xpert had a mean cost of USD 17.37 with an ABC of USD 10.86, while smear microscopy had a mean cost of USD 13.31 with an ABC of USD 6.01. The sensitivity of smear microscopy was 42.9% and its specificity was 99.1%, while the Xpert assay had a sensitivity of 100% and a specificity of 96.7%. Conclusions: The Xpert assay has high accuracy; however, the turnaround time and cost of smear microscopy were lower than those of Xpert.

A systematic review of the costs of diagnosis for multidrug-resistant/extensively drug-resistant TB in different settings

“…Following the World Bank country classification for years 2021-2022 16 , data were collected for 2 High Income 33,34,42 , 2 Low Income 18, 21,28,29,32,38,39 , 5 Lower-middle Income 19,20,23,27,38 , and 3 Uppermiddle Income countries 22,[24][25][26]30,31,[35][36][37][38]40,41 (Table 1). Total Cost per rapid TB test ranged from $12.41 28 to $218 33 , reagents and consumable from $1.13 20 to $74.60 34 and equipment ranged from $0.40 25 to $14.34 34 .…”

Cost analysis of GenoType® MTBDRplus and GenoType® MTBDRsl at the State Laboratory of São Paulo, Brazil

“…Certain Brazilian studies have also evaluated ABC as a diagnostic method; for the identification test, bacilloscopy had an ABC of US$ 6.01 and a subsidized Xpert of US$ 10.86 12 . For the cost evaluation of sensitivity methods, the GenoType ® MTBDRplus molecular test was US$ 48.38 12 and, in our study, the ABC of GenoType was US$ 35.80; the difference are due to the differences in the laboratories where the studies were performed. The phenotypic methods had higher costs, with US$ 76.56 for the sensitivity test for each drug using BACTEC MGIT 360 and US$ 136.80 for the proportion method 11 .…”

“…The accuracy and cost of conventional and molecular methods for the diagnosis of MDR-TB have been described in several countries [8][9][10] , including Brazil [11][12][13] . However, data on the costs incurred with the use of molecular tests in Public Health Laboratories are scarce, and the information obtained can be used to optimize resource management health services in countries with a unified health system, such as Brazil, particularly with the recent incorporation of GenoType ® MTBDRplus and GenoType ® MTBDRsl 14 .…”

Activity-based costing (ABC) in SMEs and innovative initiatives: possible option or expired?

“…Estudios recientes sostienen que la detección rápida y precisa de la tuberculosis (TBC) es indispensable para mejorar el diagnóstico del paciente y reducir la transmisión de la enfermedad; por lo que, al igual que el tratamiento, resultó ser más eficaz el uso de la determinación de los precios de tratamiento calculados con base en el costo medio utilizando el costeo basado en actividades (ABC), costos determinados que resultaron ser significativamente menores que los sistemas tradicionales, atendidos con un equipo multidisciplinario. Consiguientemente, el sistema ABC permitió también cuantificar costos de entrevistas y observaciones a los trabajadores de la salud incluido sus pacientes en cada etapa de la vía de tratamiento, para así evaluar los niveles de satisfacción y, consecuentemente, administrar la priorización, planificación, presupuestación operativa, evaluación económica de programas, intervención y manejo de enfermedades (Bay et al, 2017;Chirenda et al, 2021;Figueredo et al, 2020).…”