title: Comparing multidrug-resistant tuberculosis patient costs under molecular diagnostic algorithms in South Africa.
abstract: METHODS
  Ten primary health care facilities in Cape Town, South Africa, 2010-2013.
  
  
  OBJECTIVE
  A comparison of costs incurred by patients in GenoType MDRTBplus line-probe assay (LPA) and Xpert MTB/RIF-based diagnostic algorithms from symptom onset until treatment initiation for multidrug-resistant tuberculosis (MDR-TB).
  
  
  METHODS
  Eligible patients identified from laboratory and facility records were interviewed 3-6 months after treatment initiation and a cost questionnaire completed. Direct and indirect costs, individual and household income, loss of individual income and change in household income were recorded in local currency, adjusted to 2013 costs and converted to $US.
  
  
  RESULTS
  Median number of visits to initiation of MDR-TB treatment was reduced from 20 to 7 (P < 0.001) and median costs fell from US$68.1 to US$38.3 (P = 0.004) in the Xpert group. From symptom onset to being interviewed, the proportion of unemployed increased from 39% to 73% in the LPA group (P < 0.001) and from 53% to 89% in the Xpert group (P < 0.001). Median household income decreased by 16% in the LPA group and by 13% in the Xpert group.
  
  
  CONCLUSIONS
  The introduction of an Xpert-based algorithm brought relief by reducing the costs incurred by patients, but loss of employment and income persist. Patients require support to mitigate this impact.
authors.affiliation: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.
authors.forename: E
authors.initials: E
authors.lastname: du Toit
authors.affiliation: Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: S B
authors.initials: SB
authors.lastname: Squire
authors.affiliation: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.
authors.forename: R
authors.initials: R
authors.lastname: Dunbar
authors.affiliation: Biostatistics Unit, Centre for Evidence Based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.
authors.forename: R
authors.initials: R
authors.lastname: Machekano
authors.affiliation: Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: J
authors.initials: J
authors.lastname: Madan
authors.affiliation: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.
authors.forename: N
authors.initials: N
authors.lastname: Beyers
authors.affiliation: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.
authors.forename: P
authors.initials: P
authors.lastname: Naidoo
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D000995:Antitubercular Agents / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques / Q000191:economics / Q000379:methods*; D011320:Primary Health Care; D013019:South Africa; D011795:Surveys and Questionnaires; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*; D014478:Unemployment / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents