title: Costs and cost-effectiveness of tuberculosis cultures using solid and liquid media in a developing country.
abstract: METHODS
  The expansion of culture has been proposed to aid tuberculosis (TB) control in developing countries.
  
  
  OBJECTIVE
  To examine the cost and cost-effectiveness at the Zambian National TB Reference Laboratory of homemade and commercially produced Löwenstein-Jensen culture (HLJ and CLJ) as well as automated and manually read liquid culture (AMGIT and MMGIT).
  
  
  METHODS
  Costs were estimated from the provider's perspective and based on the average monthly throughput. Cost-effectiveness estimates were based on yield during the study period.
  
  
  RESULTS
  All techniques show comparable costs per culture (between US$28 and $32). Costs per Mycobacterium tuberculosis specimen detected were respectively US$197, $202, $312 and $340 for MMGIT, AMGIT, CLJ and HLJ. When modelled for the maximum throughput, costs were above US$95 per M. tuberculosis specimen detected for all techniques. When only performed among smear-negative specimens, costs per additionally identified M. tuberculosis would be US$487 for MMGIT and higher for other methods.
  
  
  CONCLUSIONS
  Based on cost-effectiveness grounds, liquid media compare well with conventional solid media, especially where yield of MGIT is substantially higher than that of LJ media. The results indicate high overall costs per culture; the expansion of culture to decentralised levels with lower throughputs may result in even higher costs.
authors.affiliation: Health Economics and Financing Programme, Department of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK. dirk.mueller@lshtm.ac.uk
authors.forename: D H
authors.initials: DH
authors.lastname: Mueller
authors.forename: L
authors.initials: L
authors.lastname: Mwenge
authors.forename: M
authors.initials: M
authors.lastname: Muyoyeta
authors.forename: M W
authors.initials: MW
authors.lastname: Muvwimi
authors.forename: R
authors.initials: R
authors.lastname: Tembwe
authors.forename: R
authors.initials: R
authors.lastname: McNerney
authors.forename: P
authors.initials: P
authors.lastname: Godfrey-Faussett
authors.forename: H M
authors.initials: HM
authors.lastname: Ayles
mesh_terms: D001431:Bacteriological Techniques / Q000191:economics*; D003362:Cost-Benefit Analysis / Q000379:methods*; D003365:Costs and Cost Analysis; D003470:Culture Media / Q000191:economics; D003906:Developing Countries; D006801:Humans; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis*; D015024:Zambia
chemical_list: D003470:Culture Media