Genotype®MTBDRplus and Xpert®MTB/RIF in the diagnosis of tuberculosis and resistant tuberculosis: cost analysis in a tertiary referral hospital

Abstract INTRODUCTION: The present study sought to assess the mean and activity based cost (ABC) of the laboratory diagnosis for tuberculosis through the application of conventional and molecular techniques-Xpert®MTB/RIF and Genotype®MTBDRplus-in a tertiary referral hospital in Brazil. METHODS: The mean cost and ABC formed the basis for the cost analysis of the TB laboratory diagnosis. RESULTS: The mean cost and ABC were US$ 4.00 and US$ 3.24, respectively, for a bacilloscopy; US$ 6.73 and US$ 5.27 for a Lowenstein-Jensen (LJ) culture; US$ 105.42 and US$ 76.56 for a drug sensitivity test (DST)-proportions method (PM) in LJ; US$ 148.45 and US$ 136.80 for a DST-BACTECTM MGITTM 960 system; US$ 11.53 and US$ 9.89 for an Xpert®MTB/RIF; and US$ 84.21 and US$ 48.38 for a Genotype®MTBDRplus. CONCLUSIONS: The mean cost and ABC proved to be good decision-making parameters in the diagnosis of TB and MDR-TB. The effective implementation of algorithms will depend on the conditions at each location.

Avaliação do atendimento laboratorial a sintomáticos respiratórios para tuberculose que procuraram serviços de saúde em Canoas, Rio Grande do Sul, Brasil, 2012 / Evaluation of laboratory care provided to patients with respiratory symptoms of tuberculosis seeking public health services in Canoas, Rio Grande do Sul, Brazil, 2012 / Evaluación del atendimiento laboratorial en sintomáticos respiratorios para tuberculosis que buscaron servicios de salud en Canoas, Rio Grande del Sul, Brasil, 2012

OBJETIVO: descrever o tempo decorrido entre a identificação do sintomático respiratório para tuberculose e a liberação do resultado laboratorial, bem como entre a obtenção do resultado e o início do tratamento. MÉTODOS: estudo descritivo, com dados de casos suspeitos de tuberculose atendidos em serviços públicos de saúde no município de Canoas-RS, Brasil, em 2012. RESULTADOS: foram examinados 1.138 pacientes, com positividade de 7,47%; as medianas de tempo (i) entre identificação do paciente e entrada da amostra de escarro no laboratório e de (ii) processamento do exame foram de 2 (intervalo interquartílico [IIQ] 1-3) e 3 dias (IIQ 1-4), respectivamente, para pacientes com resultado negativo; para pacientes com resultado positivo, esses tempos foram de 2 (IIQ 1-3) e 2,5 dias (IIQ 1-4); entre a liberação do resultado e início do tratamento, transcorreram 3 dias (IIQ 0-5). CONCLUSÃO: os tempos avaliados foram considerados longos em comparação ao preconizado pelo Ministério da Saúde.

OBJECTIVE: to describe the time interval between identification of patients with respiratory symptoms of tuberculosis and laboratory test results release, and between lab results release and commencement of treatment. METHODS: this was a descriptive study with data on patients suspected of having tuberculosis who attended public health services in Canoas-RS, Brazil, in 2012. RESULTS: tests were performed in 1138 patients and positivity rate was 7.47%; medians between (i) patient identification and the sample entering the lab and (ii) processing time were 2 days (Interquartile Range [IQR] 1-3) and 3 days (IQR 1-4), respectively, for people with negative result; for patients who tested positive, these times were 2 days (IQR 1-3) and 2.5 days (IQR 1-4), and the time between release of test results and commencement of treatment was 3 days (IQR 0-5). CONCLUSION: time intervals were considered long when compared to those recommended by the Ministry of Health.

OBJETIVO: describir el tiempo transcurrido entre la identificación de un sintomático respiratorio para tuberculosis y la liberación del resultado laboratorial, y entre la obtención del mismo y el inicio del tratamiento. MÉTODOS: estudio descriptivo que incluyó datos de pacientes con sospecha de tuberculosis que consultaron servicios públicos de salud en el municipio de Canoas-RS, Brasil, en 2012. RESULTADOS: fueron examinados 1138 pacientes, siendo positivos 7,47%; las mediana de tiempo (i) entre la identificación del paciente y entrada de la muestra al laboratorio y (ii) el procesamiento fueron 2 (intervalo interquartílico [IIQ] 1-3) y 3 días (IIQ 1-4), respectivamente, para pacientes con resultado negativo; para pacientes con resultado positivo, los tiempos fueron 2 (IIQ 1-3) y 2.5 (IIQ 1-4) días y el tiempo entre liberación del resultado e inicio del tratamiento fue 3 días (IIQ 0-5). CONCLUSIÓN: los tiempos evaluados fueron considerados largos, comparados con los recomendados por el Ministerio de Salud.