Table 1.

Economics of TB diagnostics in private sector laboratories in India.

Characteristics per single test	Sputum Smears (Z-N and fluorescent)	ELISA (serological tests for TB)	Automated liquid culture	PCR-based molecular tests
Cost of reagents and consumables (Rupees)	15	90 for TB IgG 90 for TB IgM	200 (detection) 500 (detection and drug sensitivity testing)	300 Gel PCR 500 RT-PCR 1100 Line probe assay 1400 GeneXpert
Margin + non-reagent costs to the lab (Rupees)#	85–125	310–510	700–2500	700–2100
Price to the patient (Rupees)	100–150	400–600 for a single antibody 800–1200 for TB IgG + TB IgM	900–1500 (detection) 2000–3000 (detection and drug sensitivity)	1000 Gel PCR 1500 RT-PCR 2500 Line probe assay 3500 GeneXpert
Time spent by technician	45 min	3–4 h*	1 h*	3–4 h*
Technician training time required	5 days (min)	2 days	2–3 days	2 days–2 weeks
Requirement of instrumentation (Rupees)	Microscope	ELISA reader (90,000)	Instrument (100,000–150,000)**	PCR equipment, RT-PCR, GeneXpert
Requirement of special working conditions	Moderate biosafety	Minimal biosafety	BSL III	Moderate biosafety, Separate room for each reaction step (except GeneXpert)

^#“Margin + non-reagent costs” value is aggregated because respondents were unable to clearly state the corresponding amounts. Instead, the labs said that when calculating a price of a test to patients, they would typically assume 4–7-fold increase versus the cost of a reagent.

^*Several tests can be prepared at the same time (limited by centrifuge/machine capacity).

^**Reagent rental possible (e.g. highly discounted instrument, obligation to do 10 samples/day for sensitivity testing during 3 years).