Estimated Costs of False Laboratory Diagnoses

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´╗┐Estimated Costs of False Laboratory Diagnoses
We estimated direct medical and nonmedical costs associated with a false diagnosis of tuberculosis (TB) caused by laboratory cross-contamination of Mycobacterium tuberculosis cultures in Massachusetts in 1998 and 1999. For three patients who received misdiagnoses of active TB disease on the basis of laboratory cross-contamination, the costs totaled U.S.$32,618. Of the total, 97% was attributed to the public sector (local and state health departments, public health hospital and laboratory, and county and state correctional facilities); 3% to the private sector (physicians, hospitals, and laboratories); and <1% to the patient. Hospitalizations and inpatient tests, procedures, and TB medications accounted for 69% of costs, and outpatient TB medications accounted for 18%. The average cost per patient was $10,873 (range, $1,033-$21,306). Reducing laboratory cross-contamination and quickly identifying patients with cross-contaminated cultures can prevent unnecessary and potentially dangerous treatment regimens and anguish for the patient and financial burden to the health-care system.

To date, studies investigating cases of laboratory cross-contamination have described only the resources to care for patients who received false diagnoses of tuberculosis (TB); to our knowledge, the costs attributable to cross-contamination have not been reported. We estimated direct medical and nonmedical costs for three patients whose misdiagnoses of active TB disease resulted from laboratory cross-contamination of Mycobacterium tuberculosis cultures. The costs totaled U.S.$32,618. By examining the costs from the perspective of the patient and the public and private sectors, we documented the financial costs to the health-care system caused by laboratory cross-contamination.

The rate of patients having false-positive M. tuberculosis cultures resulting from laboratory cross-contamination may be up to 33% of culture-confirmed TB patients. Reportedly two thirds of patients with false-positive cultures are treated for active TB disease and may undergo unnecessary, potentially toxic anti-TB therapy. Public health departments may initiate costly activities such as contact investigations and directly observed therapy. Dunlap et al. report that if persons who receive misdiagnoses resulting from laboratory cross-contamination were treated as TB case-patients with contact investigations and 6 months of directly observed therapy, the costs to the health-care system would be $2,500 per patient in 1993 U.S. dollars, or $3,111 in 1999 dollars, when the Medical Care component of the Consumer Price Index is used to convert 1993 dollars to 1999 dollars.

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