Analysis on the cost-effectiveness of two laboratory testing algorithms for confirmatory diagnosis of HTLV-1 and HTLV-2
Keywords:
Human T-cell lymphotropic virus type 1 (HTLV-1), HTLV-2, Western blot (WB), Real-time polymerase chain reaction (PCR), Algorithm testsAbstract
Since 1998 the Instituto Adolfo Lutz of São Paulo (IAL) has conducted serologic assays for human T-cell lymphotropic virus type 1 and type 2 (HTLV-1 and HTLV-2) in blood samples from patients from public health centers. Based on the skillful experience and the faced difficulties, the investigators of IAL evaluated several testing algorithm, searching for the most appropriate one. The present study assessed the cost-effectiveness of two test algorithms for confirming HTLV infections: Algorithm A, proposed in 2009, employs firstly the Western Blot (WB) assay and those samples with negative or inconclusive results are analyzed by real-time polymerase chain reaction (PCR) pol; and Algorithm B, proposed in 2010, employs firstly the real-time PCR, and negative samples are tested by WB. Of 73 analyzed blood samples, 53 were HTLV-1/2 positive in the algorithms. However, Algorithm A showed 19 inconclusive results, and 37% of which were confirmed by realtime PCR. Using Algorithm B, 11 blood samples showed false-negative results in real-time PCR. Thus, both confirmatory assays were complementary. Due to the high number of indeterminate results and the cost for running WB, the Algorithm B seemed to be mostly suitable. A 44% cost reduction was observed in using Algorithm B. In conclusion, in laboratories equipped to handle the real-time PCR, this assay could be employed for reducing the cost for the public health system.
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Copyright (c) 2011 Emanuela Avelar Silva Costa, Adele Caterino-de-Araujo, Karoline Rodrigues Campos
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