Xpert MTB/RIF for tuberculosis testing: access and price in highly privatised health markets

Xpert MTB/RIF (Cepheid, Sunnyvale, CA, USA) is the biggest recent advance in tuberculosis diagnosis, and since 2010 more than 15 million cartridges have been procured through concessional pricing ($9·98 per cartridge in 2015).¹ However, even in countries with a high tuberculosis burden, the private sector is not eligible for concessional pricing for Xpert, nor for other WHO-endorsed tests such as line probe assays (LPA) and liquid cultures. Manufacturers set higher prices for reagents and instruments for private laboratories and institutions than for the public sector, and there are additional costs (such as import duties), and margins imposed by distributors, intermediaries, and laboratories.