SETTING: The expansion of culture has been proposed to aid tuberculosis
(TB) control in developing countries.
OBJECTIVES: To examine the cost and cost-effectiveness at the Zambian
National TB Reference Laboratory of homemade and commercially produced
Löwenstein-Jensen culture (HLJ and CLJ) as well as automated and
manually read liquid culture (AMGIT and MMGIT).
DESIGN: Costs were estimated from the provider's perspective and based
on the average monthly throughput. Cost-effectiveness estimates were
based on yield during the study period.
RESULTS: All techniques show comparable costs per culture (between US$28
and $32). Costs per Mycobacterium tuberculosis specimen detected were
respectively US$197, $202, $312 and $340 for MMGIT, AMGIT, CLJ and HLJ.
When modelled for the maximum throughput, costs were above US$95 per M.
tuberculosis specimen detected for all techniques. When only performed
among smear-negative specimens, costs per additionally identified M.
tuberculosis would be US$487 for MMGIT and higher for other methods.
CONCLUSION: Based on cost-effectiveness grounds, liquid media compare
well with conventional solid media, especially where yield of MGIT is
substantially higher than that of LJ media. The results indicate high
overall costs per culture; the expansion of culture to decentralised
levels with lower throughputs may result in even higher costs.
International Journal of Tuberculosis and Lung Disease (2008) 12 (10) 1196-1202
Costs and cost-effectiveness of tuberculosis cultures using solid and liquid media in a developing country