title: Patient costs for the diagnosis of tuberculosis in Brazil: comparison of Xpert MTB/RIF and smear microscopy.
abstract: METHODS
  Manaus and Rio de Janeiro, two Brazilian state capitals with the country's fifth and sixth highest tuberculosis (TB) incidence rates (around 90/100,000 population in 2012).
  
  
  OBJECTIVE
  To compare the costs of the Xpert MTB/RIF assay with those of standard care (two smears) in diagnosing TB from the patient's perspective.
  
  
  METHODS
  We interviewed 218 patients diagnosed with TB in the previous 4 months by Xpert or smear microscopy. Information on non-medical direct costs for transportation and food, indirect costs such as time spent for diagnostic visits and socio-demographic data were gathered.
  
  
  RESULTS
  The median patient income was US$390.24. Median total costs incurred by patients were 54% higher with the smear process than with Xpert (US$25.24 vs. US$16.44, P < 0.000) due to higher indirect and direct costs. Male patients incurred higher indirect costs (U$10.27 vs. US$7.51, P = 0.038), and patients in Manaus incurred higher total costs.
  
  
  CONCLUSIONS
  Although the diagnosis and treatment of TB in Brazil are free of charge, non-medical direct and indirect costs for patients may represent important barriers to accessing appropriate care. Compared to standard care, Xpert reduced the financial burden for patients. These findings support the decision to scale-up Xpert technology in the country.
authors.affiliation: Post-graduate Program on Health Education, Gama Filho University, Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: R
authors.initials: R
authors.lastname: da Silva Antunes
authors.affiliation: Instituto Fernandes Figueira, Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: M
authors.initials: M
authors.lastname: Pinto
authors.affiliation: Post-graduate Program on Health Education, Gama Filho University, Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: A
authors.initials: A
authors.lastname: Trajman
mesh_terms: D000328:Adult; D001431:Bacteriological Techniques / Q000191:economics*; D001938:Brazil; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D008297:Male; D008853:Microscopy / Q000191:economics*; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D010361:Patients; D011237:Predictive Value of Tests; D012959:Socioeconomic Factors; D013183:Sputum / Q000382:microbiology*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000191:economics / Q000382:microbiology; D019037:Urban Health Services / Q000191:economics