Objective To evaluate the efficiency of different diagnosis schemes for pulmonary tuberculosis diagnosis and to provide references for selecting appropriate diagnostic schemes in areas with different economic and laboratory conditions.

Methods According to differences in laboratory equipment in various areas, we proposed four schemes (scheme A - D) for pulmonary tuberculosis diagnosis. Pathogenic positive rate, time consumed for a diagnosis of rifampicin-resistant tuberculosis, cost for a pathogenic diagnosis and for a diagnosis of rifampicin-resistant tuberculosis were estimated and compared among the four schemes. The background data for the simulation study were extracted from Final Assessment Report on National Tuberculosis Prevention and Control Program – 2011 – 2015.

Results The pathogenic positive rate of the diagnosis was 40.5% for scheme A and B and 37.4% for scheme C and D. The time consumed for a diagnosis of rifampicin-resistant tuberculosis was one day for scheme A, 5 days for scheme B and C for smear-positive cases, and 60 – 116 days for scheme D. The total cost for a diagnosis of pathogenic positive tuberculosis was 1 392, 1 423, 1 003, and 1 003 RMB yuan for scheme A, B, C, and D; the total cost for a diagnosis of rifampicin-resistant tuberculosis was 21 316, 22 409, 15 368, and 12 191 RMB yuan for scheme A, B, C, and D, respectively.

Conclusion Diagnosis rate of pathogenic positive tuberculosis could be increased and the time for diagnosis of rifampicin-resistant tuberculosis could be shortened in counties/districts with laboratories equipped by nucleic acid detection devices; the time for diagnosis of smear-positive drug-resistant tuberculosis could be shortened in cities/prefectures with laboratories having capability for molecular biological drug-resistance detection.