Patient costs for the diagnosis of tuberculosis in Brazil: comparison of Xpert MTB/RIF and smear microscopy.

SETTING: 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.

METHOD: 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.