title: Comparison of laboratory costs of rapid molecular tests and conventional diagnostics for detection of tuberculosis and drug-resistant tuberculosis in South Africa.
abstract: BACKGROUND
  The World Health Organization has endorsed the use of molecular methods for the detection of TB and drug-resistant TB as a rapid alternative to culture-based systems. In South Africa, the Xpert MTB/Rif assay and the GenoType MTBDRplus have been implemented into reference laboratories for diagnosis of TB and drug-resistance, but their costs have not been fully elucidated.
  
  
  METHODS
  We conducted a detailed reference laboratory cost analysis of new rapid molecular assays (Xpert and MTBDRplus) for tuberculosis testing and drug-resistance testing in South Africa, and compared with the costs of conventional approaches involving sputum microscopy, liquid mycobacterial culture, and phenotypic drug sensitivity testing.
  
  
  RESULTS
  From a laboratory perspective, Xpert MTB/RIF cost $14.93/sample and the MTBDRplus line probe assay cost $23.46/sample, compared to $16.88/sample using conventional automated liquid culture-based methods. Laboratory costs of Xpert and MTBDRplus were most influenced by cost of consumables (60-80%).
  
  
  CONCLUSIONS
  At current public sector pricing, Xpert MTB/RIF and MTBDRplus are comparable in cost to mycobacterial culture and conventional drug sensitivity testing. Overall, reference laboratories must balance costs with performance characteristics and the need for rapid results.
authors.affiliation: Johns Hopkins University School of Medicine, Department of Medicine, Division of Infectious Disease, 1503 East Jefferson St, Room 118, Baltimore, MD 21231, USA. Mshah28@JHMI.EDU
authors.forename: Maunank
authors.initials: M
authors.lastname: Shah
authors.forename: Violet
authors.initials: V
authors.lastname: Chihota
authors.forename: Gerrit
authors.initials: G
authors.lastname: Coetzee
authors.forename: Gavin
authors.initials: G
authors.lastname: Churchyard
authors.forename: Susan E
authors.initials: SE
authors.lastname: Dorman
mesh_terms: D000465:Algorithms; D015373:Bacterial Typing Techniques / Q000191:economics* / Q000295:instrumentation; D006801:Humans; D008856:Microscopy, Fluorescence / Q000191:economics / Q000295:instrumentation; D009169:Mycobacterium tuberculosis / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D013019:South Africa; D014376:Tuberculosis / Q000175:diagnosis* / Q000191:economics*; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis* / Q000191:economics*
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