title: Cost analysis of different diagnostic algorithms for pulmonary tuberculosis varying in placement of Xpert MTB/RIF.
abstract: We undertook cost analysis for diagnosis of pulmonary tuberculosis (PTB) using present algorithm under Revised National Tuberculosis Control programme and using Xpert MTB/RIF (Xpert) as frontline test or in conjunction with smear microscopy and/or chest radiography.
  
  
  
  Costs were estimated for different strategies: (A) present algorithm involving sputum smear examination followed by antibiotic trial in smear negative patients, repeat smear examination (RE) if symptoms continue and chest radiography if RE negative; (B) direct Xpert; (C) smear microscopy followed by Xpert in smear negative patients; (D) radiography followed by Xpert in those having abnormal pulmonary shadows; and (E) smear examination followed by radiography among smear negative patients and Xpert in presence of abnormal pulmonary shadow.
  
  
  
  Cost to program was estimated lowest with Strategy A and highest with Strategy B. Compared to the latter, program cost reduces by 7%, 4.5%, and 17.4% by strategies C, D, and E, respectively. Cost to the group of individuals with presumptive PTB and their attendants is significantly higher for Strategy A compared to other four strategies. Among the latter, the patients' cost was minimum with Strategy B and maximum with Strategy C. Program cost per case diagnosed was lowest by Strategy A and highest by Strategy B. Patient cost per case diagnosed was highest by Strategy A and lowest by Strategy B. Using Xpert, Strategy E had the lowest program as well as overall cost per case diagnosed.
  
  
  
  Strategy E may be chosen for diagnosis of PTB. When resources would no longer be a constraint, direct Xpert would reduce costs incurred by the patients.
authors.affiliation: Epidemiology & Research Division, National Tuberculosis Institute, Bangalore, Karnataka, India. Electronic address: vineet2.chadha@gmail.com.
authors.forename: V K
authors.initials: VK
authors.lastname: Chadha
authors.affiliation: Laboratory Division, National Tuberculosis Institute, Bangalore, Karnataka, India.
authors.forename: George
authors.initials: G
authors.lastname: Sebastian
authors.affiliation: Office of the Director, National Tuberuclosis Institute, Bangalore, Karnataka, India.
authors.forename: P
authors.initials: P
authors.lastname: Kumar
mesh_terms: D000465:Algorithms; D003365:Costs and Cost Analysis; D006801:Humans; D007194:India; D008853:Microscopy / Q000191:economics; D009161:Mycobacterium / Q000235:genetics; D021141:Nucleic Acid Amplification Techniques / Q000191:economics / Q000295:instrumentation; D013902:Radiography, Thoracic / Q000191:economics; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000191:economics*
keywords: Cost; Diagnostic algorithms; India; Pulmonary tuberculosis; Revised National Tuberculosis Control Programme