55 results on '"Immunologic Tests economics"'
Search Results
2. Hepatitis C virus antigen detection is an appropriate test for screening and early diagnosis of hepatitis C virus infection in at-risk populations and immunocompromised hosts.
- Author
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Kumar R, Chan KP, Ekstrom VSM, Wong JCC, Lim KL, Ng WC, Woo SM, Chan KS, Thangaraju S, Kee TYS, Gan SSW, Foo MWY, Oon LLE, and Chow WC
- Subjects
- Adult, Early Diagnosis, Female, Hepacivirus chemistry, Hepatitis C blood, Hepatitis C prevention & control, Hepatitis C Antigens blood, Hepatitis C Antigens immunology, Hepatitis C, Chronic blood, Hepatitis C, Chronic prevention & control, Humans, Immunologic Tests economics, Immunologic Tests standards, Male, Mass Screening, Middle Aged, Predictive Value of Tests, RNA, Viral blood, RNA, Viral genetics, Sensitivity and Specificity, Hepacivirus genetics, Hepatitis C diagnosis, Hepatitis C Antigens analysis, Hepatitis C, Chronic diagnosis, Immunocompromised Host, Immunologic Tests methods
- Abstract
Early diagnosis remains key for effective prevention and treatment. Unfortunately, current screening with anti-hepatitis C virus antibody (anti-HCV Ab) test may have limited utility in the diagnosis of HCV infection and reinfection. This is of special concern to at-risk population, such as immunocompromised hosts and end-stage renal failure patients on hemodialysis. HCV antigen (Ag) could be useful in identifying the ongoing infection in such clinical scenarios. Hence, we aimed to study the utility of HCV Ag testing for the diagnosis of acute and chronic hepatitis C. Of 89 samples studied, 19 were from acute hepatitis C patients who were immunocompromised or were on hemodialysis, 43 were from active chronic hepatitis C patients and 27 were from patients treated for chronic hepatitis C. All samples were tested for HCV Ag using the Abbott ARCHITECT HCV Ag assay. HCV Ag was reactive in 19/19 samples from acute hepatitis C patients and 42/43 samples from active chronic hepatitis C patients. It was nonreactive in all samples from treated patients. The test showed a sensitivity and specificity of 98.4% and 100.0%, respectively. The positive and negative predictive values were 100.0% and 96.4%, respectively. The HCV antigen test has high clinical sensitivity and specificity and is useful for the diagnosis of acute and chronic hepatitis C infection in at-risk and immunocompromised patients. Its short turnaround time and relatively low cost are advantageous for use in patients on hemodialysis and other at-risk patients who require monitoring of HCV infection and reinfection., (© 2020 Wiley Periodicals LLC.)
- Published
- 2021
- Full Text
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3. Well-Based Antibody Arrays.
- Author
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Matson RS
- Subjects
- Animals, Automation, Laboratory methods, Automation, Laboratory standards, Humans, Immunoenzyme Techniques methods, Immunoenzyme Techniques standards, Immunologic Tests economics, Immunologic Tests standards, Protein Array Analysis standards, Sensitivity and Specificity, Immunologic Tests methods, Protein Array Analysis methods
- Abstract
Multiplex immunoassays are important tools in basic research and diagnostics. The ability to accurately quantify the presence of several antigens within an individual sample all at once has been useful in developing a proteomics view of biology. This in turn has enabled the development of disease-associated immunodiagnostic panels for better prognosis and well-being. Moreover, it is well understood that such multiplexing approaches lend themselves to automation, thereby reducing labor while providing the ability to dramatically conserve both reagent and sample all of which will reduce the cost per test. Here we describe various methods to create and use multiplex immunoassays in the wells of microtiter plates or similar formats.
- Published
- 2021
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4. Allergy Testing - An Overview.
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Gupta N, Agarwal P, Sachdev A, and Gupta D
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- Child, Cost-Benefit Analysis, Humans, Hypersensitivity classification, Hypersensitivity psychology, Quality of Life, Treatment Outcome, Hypersensitivity diagnosis, Immunologic Tests economics, Immunologic Tests methods
- Abstract
Childhood allergies pose huge economic burden and adverse effects on quality of life. Serum IgE has been considered a surrogate allergy marker for decades. Availability of several over-the-counter allergy tests add to confusion of partially trained caregivers. The present review focuses on current status of allergy testing in Indian scenario. Various in-vitro and in-vivo diagnostic modalities are available for allergy detection. Skin prick tests are useful for aero-allergies whereas oral challenge tests are best for identifying suspected food allergies. An allergy test should be individualized based on clinical features, diagnostic efficacy, and cost-benefit analysis.
- Published
- 2019
5. Impact of Adopting Routine Luminex-Based Pretransplant Assessment of HLA Antibodies on Clinical Practice and Outcomes in Kidney Transplantation.
- Author
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NasrAllah MM, Elalfy MM, Fakhry SA, Rostaing L, Amer I, Elmeseery YA, Mohammed IS, El-Gamal AM, and Malvezzi P
- Subjects
- Antibodies immunology, Cost-Benefit Analysis, Feasibility Studies, Female, Humans, Immunologic Tests economics, Male, Middle Aged, Preoperative Period, Reproducibility of Results, Transplantation, Homologous, Antibodies analysis, Graft Rejection immunology, HLA Antigens immunology, Immunologic Tests methods, Kidney Transplantation adverse effects
- Abstract
Background: Accumulating evidence suggests that detection of human leukocyte antigen (HLA) antibodies by solid phase Luminex assays predicts renal allograft outcomes. However, several controversies exist regarding the interpretation, reproducibility, impact and financial feasibility of global utilization of this assay in pretransplant assessment., Methods: We studied short-term patient-centered outcomes, medical standards of care, and financial plausibility of using Luminex-based screening for HLA antibodies in renal allograft recipients compared to outcomes in nontested patients., Results: We included 1808 patients assessed for transplantation from 2011 to 2018. Luminex-tested patients had lower rates of rejection in the first post-transplant week (OR 0.36, P < .001) and lower odds of antibody-mediated rejection in the first 6 months (OR 0.4, P = .004). Forty-four patients with preformed, donor-specific antibodies were transplanted, and everolimus was introduced into our protocols for low-risk patients based on risk stratification by Luminex results. The number of tests needed to be performed to prevent 1 episode of antibody-mediated rejection in the first 6 months was 28 (P = .004), which was financially plausible., Conclusions: Routine pre-transplant assessment of HLA antibodies using Luminex assays may allow for better patient-centered, short-term graft outcomes and objective tailoring of immunosuppression at a financially plausible, cost-effective rate., (Copyright © 2019 Elsevier Inc. All rights reserved.)
- Published
- 2019
- Full Text
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6. HCV core antigen comes of age: a new opportunity for the diagnosis of hepatitis C virus infection.
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Galli C, Julicher P, and Plebani M
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- Costs and Cost Analysis, Hepacivirus genetics, Hepatitis C, Chronic blood, Humans, Immunologic Tests economics, RNA, Viral blood, Viral Load, Hepatitis C Antigens blood, Hepatitis C, Chronic diagnosis, Viral Core Proteins blood
- Abstract
The diagnosis of hepatitis C virus (HCV) infection has been traditionally based on the detection of the host antibody response. Although antibody assays are available in different formats and are fairly accurate, they cannot distinguish between an ongoing infection with HCV replicative activity and a past infection where HCV has been cleared, spontaneously or after a successful therapy. As a chronic infection is mostly asymptomatic until the late clinical stages, there is a compelling need to detect active HCV infection by simple and reproducible methods. On this purpose, the clinical guidelines have suggested to search for the HCV ribonucleic acid (HCV-RNA) after anti-HCV has been detected, but this second step carries several limitations especially for population screening. The availability of fast and automated serological assays for the hepatitis C core antigen (HCVAg) has prompted an update of the guidelines that now encompass the use of HCVAg as a practical alternative to HCV-RNA, both for screening and monitoring purposes. In this paper, we summarize the features, benefits and limitations of HCVAg testing and provide an updated compendium of the evidences on its clinical utility and on the indications for use.
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- 2018
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7. Sensitivity, specificity and comparison of three commercially available immunological tests in the diagnosis of Cryptosporidium species in animals.
- Author
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Danišová O, Halánová M, Valenčáková A, and Luptáková L
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- Animals, Cryptosporidiosis diagnosis, Cryptosporidium genetics, Cryptosporidium immunology, Diarrhea diagnosis, Diarrhea microbiology, Immunologic Tests economics, Immunologic Tests veterinary, Sensitivity and Specificity, Cryptosporidiosis microbiology, Cryptosporidium isolation & purification, Diarrhea veterinary, Immunologic Tests methods
- Abstract
The study was conducted to compare the specificity of immunological diagnostic methods used for the diagnosis of Cryptosporidium species capable of causing life-threatening infection in both immunosuppressed and immunocompetent patients. For the detection of Cryptosporidium species in 79 animals with diarrhoea, we used three Copro-antigen tests: RIDASCREEN
® Cryptosporidium test, Cryptosporidium 2nd Generation (ELISA) and RIDA® QUICK Cryptosporidium. For immunoassays we used positive and negative samples detected by means of polymerase chain reaction and validated by sequencing and nested polymerase chain reaction to confirm the presence six different species of Cryptosporidium species. Prevalence of cryptosporidiosis in the entire group determined by enzyme immunoassay, enzyme linked immunosorbent assay, immuno-chromatographic test and polymerase chain reaction was 34.17%, 27.84%, 6.33% and 27.84%, respectively. Sensitivity of animal samples with enzyme immunoassay, enzyme linked immunosorbent assay, and immuno-chromatographic test was 63.6%, 40.9% and 22.7%, resp., when questionable samples were considered positive, whereas specificity of enzyme immunoassay, enzyme linked immunosorbent assay and immuno-chromatographic test was 75.9%, 78.9% and 100%, respectively. Positive predictive values and negative predictive values were different for all the tests. These differences results are controversial and therefore reliability and reproducibility of immunoassays as the only diagnostic method is questionable. The use of various Cryptosporidium species in diagnosis based on immunological testing and different results obtained by individual tests indicate potential differences in Copro-antigens produced by individual Cryptosporidium species., (Copyright © 2017 Sociedade Brasileira de Microbiologia. Published by Elsevier Editora Ltda. All rights reserved.)- Published
- 2018
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8. Greater Real-Life Diagnostic Efficacy of Allergen Molecule-Based Diagnosis for Prescription of Immunotherapy in an Area with Multiple Pollen Exposure.
- Author
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Saltabayeva U, Garib V, Morenko M, Rosenson R, Ispayeva Z, Gatauova M, Zulus L, Karaulov A, Gastager F, and Valenta R
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- Adolescent, Adult, Child, Child, Preschool, Costs and Cost Analysis, Female, Humans, Immunoglobulin E blood, Immunologic Tests economics, Male, Middle Aged, Rhinitis, Allergic economics, Rhinitis, Allergic immunology, Rhinitis, Allergic therapy, Young Adult, Allergens immunology, Desensitization, Immunologic, Immunologic Tests methods, Plant Proteins immunology, Pollen immunology, Rhinitis, Allergic diagnosis
- Abstract
Background: Allergen molecule-based diagnosis has been suggested to facilitate the identification of disease-causing allergen sources and the prescription of allergen-specific immunotherapy (AIT). The aim of the current study was to compare allergen molecule-based IgE serology with allergen extract-based skin testing for the identification of the disease-causing allergen sources. The study was conducted in an area where patients are exposed to pollen from multiple sources (trees, grasses, and weeds) at the same time to compare the diagnostic efficiency of the 2 forms of diagnosis., Methods: Patients from Astana, Kazakhstan, who suffered from pollen-induced allergy (n = 95) were subjected to skin prick testing (SPT) with a local panel of tree pollen, grass pollen, and weed pollen allergen extracts and IgE antibodies specific for marker allergen molecules (nArt v 1, nArt v 3, rAmb a 1, rPhl p 1, rPhl p 5, rBet v 1) were measured by ImmunoCAP. Direct and indirect costs for diagnosis based on SPT and marker allergen-based IgE serology as well as direct costs for immunotherapy depending on SPT and serological test results were calculated., Results: The costs for SPT-based diagnosis per patient were lower than the costs for allergen molecule-based IgE serology. However, allergen molecule-based serology was more precise in detecting the disease-causing allergen sources. A lower number of immunotherapy treatments (n = 119) was needed according to molecular diagnosis as compared to extract-based diagnosis (n = 275), which considerably reduced the total costs for diagnosis and for a 3-year treatment from EUR 1,112.30 to 521.77 per patient., Conclusions: The results from this real-life study show that SPT is less expensive than allergen molecule-based diagnostic testing, but molecular diagnosis allowed more precise prescription of immunotherapy which substantially reduced treatment costs and combined costs for diagnosis and treatment., (© 2017 The Author(s) Published by S. Karger AG, Basel.)
- Published
- 2017
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9. [Rising demand for immunodiagnosis].
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Stoschek J
- Subjects
- Cost-Benefit Analysis trends, Drug Industry economics, Forecasting, Germany, Health Services Needs and Demand economics, Immunologic Tests economics, Precision Medicine economics, Drug Industry trends, Health Services Needs and Demand trends, Immunologic Tests trends, Precision Medicine trends
- Published
- 2015
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10. Determining safe alternatives for multidrug hypersensitive patients with the alternative triple antibiotic-analgesic test.
- Author
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Ozturk AB, Celebioglu E, Karakaya G, and Kalyoncu AF
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- Administration, Oral, Adolescent, Adult, Analgesics, Non-Narcotic adverse effects, Angioedema chemically induced, Cost-Benefit Analysis, Drug Hypersensitivity etiology, Female, Humans, Immunologic Tests adverse effects, Immunologic Tests economics, Male, Middle Aged, Time Factors, Turkey, Urticaria chemically induced, Young Adult, Anti-Bacterial Agents adverse effects, Anti-Inflammatory Agents, Non-Steroidal adverse effects, Drug Hypersensitivity diagnosis, Immunologic Tests methods
- Abstract
Background: Drug provocation tests (DPTs) need technical equipment, staff and time. There are very few allergy centres performing DPTs in Turkey. Therefore many patients are referred to these centres. One day triple-double antibiotic or non-steroidal anti-inflammatory drug (NSAID) oral DPT for determining safe alternatives is safe, cost-effective and time saving compared to conventional one day one drug oral DPT. Our aim was to investigate the safety of antibiotic-NSAID oral DPT performed on the same day to find safe alternatives in multidrug hypersensitive patients., Methods: Forty-two patients who had been diagnosed as having both antibiotic and NSAID hypersensitivity were enrolled to the study between 15 November and 15 July 2010. The reactions were urticaria and/or angio-oedema not including laryngeal oedema for all patients. Two antibiotics-one NSAID or two NSAIDs-one antibiotic triple test have been performed on the same day to study patients (n=22), while the control group (n=20) had taken drugs on three separate days., Results: Only two patients had positive reactions during triple test and two patients had adverse reactions; one had gastric pain, one had nausea. Three patients in the control group had positive reactions. There were no significant differences between the two groups in frequency of adverse and allergic drug reactions (p>0.05). Sixty days were spent for the tests of the control group with only 28 days for the study population., Conclusion: Triple test performed with antibiotic and NSAID on the same day for determining safe alternatives for multidrug hypersensitive patients reporting non-life-threatening allergic reactions seems to be safe and time-saving., (Copyright © 2011 SEICAP. Published by Elsevier Espana. All rights reserved.)
- Published
- 2013
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11. New developments in the immunodiagnosis of brucellosis in livestock and wildlife.
- Author
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McGiven JA
- Subjects
- Animals, Brucellosis diagnosis, Brucellosis immunology, Immunologic Tests economics, Immunologic Tests methods, Sensitivity and Specificity, Animals, Wild, Brucellosis veterinary, Immunologic Tests veterinary, Livestock
- Abstract
Although relatively effective diagnostic tests for brucellosis have been in existence for more than 100 years, it remains a serious, embedded and also a re-emerging disease in many parts of the globe. There are many factors besides suboptimal diagnosis that impede the complete and sustained eradication of animal brucellosis. In this review a case for the continued improvement of diagnostic methods is made through identifying existing shortcomings and considering what impact these have upon control and eradication. The focus is on developments in immunodiagnostics as these seem more likely to yield the pragmatic solutions needed. Moreover, developments in DNA detection methods have been neatly and recently reviewed elsewhere. This article reviews issues such as test cost, mobility, sensitivity and specificity. Advances in low-cost materials, high-throughput testing, assay multiplexing and the quantification of pen-side tests are described and their relevance to disease control considered. Poor test specificity when resolving positive serology, due to infection with cross-reactive bacteria and vaccination with smooth Brucella strains, is also an impediment to efficient disease eradication. A case for the development of novel discrete epitope antigens to address this is presented alongside in silico methods of selection and tools that enable increased analytical sensitivity that may be required to detect relatively low, but potentially significant, analytes. References have been drawn from the study of brucellosis wherever possible. However, in some cases new technological developments worthy of discussion have been included via the use of pertinent alternative examples. In conclusion, despite developments and innovations the classical serological tests seem under no imminent danger of mass extinction but there is potential for significant improvement and supplementation.
- Published
- 2013
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12. Identification and discrimination of snake venoms from Egyptian elapids.
- Author
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Ibrahim NM, El-Kady EM, Katamesh RA, El-Borei IH, and Wahby AF
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- Animals, Antibodies blood, Antibody Affinity, Antibody Specificity, Cross Reactions immunology, Egypt, Elapid Venoms immunology, Enzyme-Linked Immunosorbent Assay, Humans, Immune Sera immunology, Immunologic Tests economics, Rabbits, Snake Bites immunology, Species Specificity, Antibodies immunology, Elapid Venoms chemistry, Elapid Venoms isolation & purification, Immunologic Tests methods, Snake Bites diagnosis
- Abstract
The avidity to the corresponding antigens is often higher than to the cross-reactive antigens. This was demonstrated with the highly cross-reactive elapid Egyptian snake venoms Naja haje (Nh), Naja nigricollis (Nn) and Walterinnesia aegyptia (Wa), and used for the differentiation among the three species in a simple ELISA-based assay. A three-step immuno-affinity protocol was followed and the titer and avidity of the different antibody (Ab) preparations were assessed and evaluated. The advantages offered by the avidity power of the venom specific antibodies (VS-Abs) obtained after one step purification, outweigh the specificity of the species-specific antibodies (SS-Abs) obtained after further purification. The efficiency of the VS-Abs as special immunodiagnostics was validated using 16 venom samples collected from individual snakes of different size and age at different time intervals. The avidities of the VS-Abs to the homologous venoms were 2.53 ± 0.4, 2.66 ± 0.31 and 2.8 ± 0.06 for Nh, Nn and Wa venoms respectively; whereas the avidity of the same Abs to the heterologous venoms could hardly exceed 1. Venom concentrations in the range between 10-1250 ng/well were detected with almost the same efficiency, an extra advantage that could be added to the assay to assure equal sensitivity allover the mentioned venom concentration range., (Copyright © 2012 Elsevier Ltd. All rights reserved.)
- Published
- 2013
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13. Developing a framework for risk-based surveillance of tuberculosis in cattle: a case study of its application in Scotland.
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Bessell PR, Orton R, O'Hare A, Mellor DJ, Logue D, and Kao RR
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- Animals, Cattle, Immunologic Tests economics, Immunologic Tests methods, Incidence, Prevalence, Risk, Scotland epidemiology, Abattoirs standards, Epidemiological Monitoring veterinary, Immunologic Tests veterinary, Mycobacterium bovis pathogenicity, Tuberculosis, Bovine epidemiology
- Abstract
Due to its substantially lower prevalence of bovine tuberculosis (bTB) relative to other areas of Great Britain, Scotland was designated as an officially (bovine) TB-free region in 2009. This paper investigates resultant possibilities for reducing surveillance by developing risk-based alternatives to current 4-year testing of eligible herds. A model of freedom of infection was used to develop strategies that specifically tested herds that are at risk of infection but would probably not be identified by slaughterhouse meat inspection. The performance of current testing is mimicked by testing all herds that slaughter fewer than 25% of their total stock per year and regularly import animals from high-incidence areas of England and Wales or from Ireland. This system offers a cost reduction by requiring 25% fewer herd and animal tests and 25% fewer false positives.
- Published
- 2013
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14. Are anti-nucleosome antibodies a better diagnostic marker than anti-dsDNA antibodies for systemic lupus erythematosus? A systematic review and a study of metanalysis.
- Author
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Bizzaro N, Villalta D, Giavarina D, and Tozzoli R
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- Age Factors, Biomarkers, Disease Progression, Humans, Immunologic Tests economics, Kidney Diseases etiology, Lupus Erythematosus, Systemic complications, Lupus Erythematosus, Systemic immunology, Odds Ratio, Reproducibility of Results, Sensitivity and Specificity, Antibodies, Antinuclear, Lupus Erythematosus, Systemic diagnosis, Nucleosomes immunology, RNA, Double-Stranded immunology
- Abstract
Background: Methods to detect anti-nucleosome antibodies (ANuA) have been available for more than 10 years and the test has demonstrated its good sensitivity and high specificity in diagnosing systemic lupus erythematosus (SLE). Despite these data produced through clinical and laboratory research, the test is little used., Objective: To verify the diagnostic performance of methods for measuring ANuA and to compare them with those for anti-dsDNA antibodies., Data Sources: A systematic review of English and non-English articles using MEDLINE and EMBASE with the search terms "nucleosome", "chromatin", "anti-nucleosome antibodies" and "anti-chromatin antibodies". Additional studies were identified checking reference lists in the selected articles., Study Selection: We selected studies reporting on anti-nucleosome tests performed by quantitative immunoassays, on patients with SLE as the index disease (sensitivity) and a control group (specificity). A total of 610 titles were initially identified with the search strategy described. 548 publications were subsequently excluded based on abstract and title. Full-text review was undertaken as the next step on 62 publications providing data on anti-nucleosome testing; 25 articles were then excluded because they did not include either SLE patients or a control group, and 37 articles were selected for the metanalysis. Finally, a sub-metanalysis study was conducted on the 26 articles providing data on both ANuA and anti-dsDNA antibody assays in the same series of patients., Data Extraction: Extraction of data from selected articles was performed by two authors independently, using predefined criteria: the number of patients with SLE as the index case, and the number of healthy or diseased controls; specification of the analytical method used to detect anti-nucleosome and anti-dsDNA antibodies; the cut-off used in the study; and the sensitivity and specificity of the assay. Demographic and clinical data on the population investigated (adults or children; lupus patients with or without nephritis; patients with active or inactive disease) were also recorded and analyzed in a separate evaluation., Results: The systematic review and metanalysis showed that the overall sensitivity of the ANuA assay is 61% (confidence interval-CI, 60-62) and the specificity 94% (CI, 94-95). The overall positive likelihood ratio is 13.81 (CI, 9.05-21.09) and the negative likelihood ratio 0.38 (CI, 0.33-0.44). The odds ratio for having SLE in ANuA-positive patients is 40.7. The comparative analysis on anti-dsDNA antibodies conducted on the 26 studies which provided data for both antibodies showed that ANuA have greater diagnostic sensitivity (59.9% vs 52.4%) and a specificity rating only slightly higher (94.9% vs 94.2%). The probability that a subject with positive ANuA have SLE is 41 times greater than a subject with negative ANuA, while for anti-dsDNA the probability is 28 times greater. These figures are even more impressive in children, in whom ANuA have an odds ratio for the diagnosis of SLE of 146, compared to 51 for anti-dsDNA antibodies. In selected studies, ANuA (p<0.0001) but not anti-dsDNA antibodies (p=0.256) were significantly associated with disease activity measured by the international score systems. However, neither antibody appears to correlate with kidney involvement., Conclusions: Data from the metanalysis have shown that ANuA have equal specificity but higher sensitivity and prognostic value than anti-dsDNA antibodies in the diagnosis of SLE. Despite a certain heterogeneity among the various studies, the use of ANuA appears more efficacious than anti-dsDNA., (Copyright © 2012 Elsevier B.V. All rights reserved.)
- Published
- 2012
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15. Rescreening of persons with a negative colonoscopy result: results from a microsimulation model.
- Author
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Knudsen AB, Hur C, Gazelle GS, Schrag D, McFarland EG, and Kuntz KM
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- Adenoma prevention & control, Colonography, Computed Tomographic adverse effects, Colonography, Computed Tomographic economics, Colonoscopy adverse effects, Computer Simulation, Early Detection of Cancer adverse effects, Feces, Health Care Costs, Humans, Immunologic Tests economics, Mass Screening adverse effects, Middle Aged, Occult Blood, Patient Compliance, Sensitivity and Specificity, Time Factors, Colonoscopy economics, Colorectal Neoplasms prevention & control, Early Detection of Cancer economics, Early Detection of Cancer methods, Mass Screening economics, Mass Screening methods
- Abstract
Background: Persons with a negative result on screening colonoscopy are recommended to repeat the procedure in 10 years., Objective: To assess the effectiveness and costs of colonoscopy versus other rescreening strategies after an initial negative colonoscopy result., Design: Microsimulation model., Data Sources: Literature and data from the Surveillance, Epidemiology, and End Results program., Target Population: Persons aged 50 years who had no adenomas or cancer detected on screening colonoscopy., Time Horizon: Lifetime., Perspective: Societal., Intervention: No further screening or rescreening starting at age 60 years with colonoscopy every 10 years, annual highly sensitive guaiac fecal occult blood testing (HSFOBT), annual fecal immunochemical testing (FIT), or computed tomographic colonography (CTC) every 5 years., Outcome Measures: Lifetime cases of colorectal cancer, life expectancy, and lifetime costs per 1000 persons, assuming either perfect or imperfect adherence., Results of Base-Case Analysis: Rescreening with any method substantially reduced the risk for colorectal cancer compared with no further screening (range, 7.7 to 12.6 lifetime cases per 1000 persons [perfect adherence] and 17.7 to 20.9 lifetime cases per 1000 persons [imperfect adherence] vs. 31.3 lifetime cases per 1000 persons with no further screening). In both adherence scenarios, the differences in life-years across rescreening strategies were small (range, 30 893 to 30 902 life-years per 1000 persons [perfect adherence] vs. 30 865 to 30 869 life-years per 1000 persons [imperfect adherence]). Rescreening with HSFOBT, FIT, or CTC had fewer complications and was less costly than continuing colonoscopy., Results of Sensitivity Analysis: Results were sensitive to test-specific adherence rates., Limitation: Data on adherence to rescreening were limited., Conclusion: Compared with the currently recommended strategy of continuing colonoscopy every 10 years after an initial negative examination, rescreening at age 60 years with annual HSFOBT, annual FIT, or CTC every 5 years provides approximately the same benefit in life-years with fewer complications at a lower cost. Therefore, it is reasonable to use other methods to rescreen persons with negative colonoscopy results., Primary Funding Source: National Cancer Institute.
- Published
- 2012
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16. Screening for colorectal cancer: what fits best?
- Author
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Lee CS, Ronan L, O'Morain C, and McNamara D
- Subjects
- Colonoscopy economics, Colonoscopy methods, Cost-Benefit Analysis, Humans, Immunologic Tests economics, Immunologic Tests methods, Occult Blood, Sigmoidoscopy economics, Sigmoidoscopy methods, Colorectal Neoplasms diagnosis, Mass Screening economics, Mass Screening methods
- Abstract
Colorectal cancer (CRC) screening has been shown to be effective in reducing CRC incidence and mortality. There are currently a number of screening modalities available for implementation into a population-based CRC screening program. Each screening method offers different strengths but also possesses its own limitations as a population-based screening strategy. We review the current evidence base for accepted CRC screening tools and evaluate their merits alongside their challenges in fulfilling their role in the detection of CRC. We also aim to provide an outlook on the demands of a low-risk population-based CRC screening program with a view to providing insight as to which modality would best suit current and future needs.
- Published
- 2012
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17. [Immunodiagnosis and biomarkers in tuberculosis].
- Author
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Guio H, Vilaplana C, and Cardona PJ
- Subjects
- Adult, Antibodies, Bacterial blood, Antigens, Bacterial blood, Biomarkers, Child, Diagnosis, Differential, Global Health, Humans, Immunologic Tests economics, Immunologic Tests trends, Infant, Newborn, Interferon-gamma blood, Latent Tuberculosis diagnosis, Latent Tuberculosis epidemiology, Latent Tuberculosis immunology, Mycobacterium tuberculosis immunology, Mycobacterium tuberculosis isolation & purification, Risk Factors, Sputum microbiology, Tuberculin Test, Tuberculosis epidemiology, Tuberculosis immunology, Immunologic Tests methods, Tuberculosis diagnosis
- Abstract
Based on the tuberculin skin test it is estimated that latent tuberculosis infection is present in one-third of the world's population. The new strategies in public health and research are aimed to reduce and eradicate this enormous reservoir. However, the absence of effective biomarkers for diagnosis and treatment of latent tuberculosis limits the development of new drugs and vaccines. Some components are present in both, the PPD (used in the tuberculin skin test) and the BCG vaccine. This increases the number of false positives in vaccinated individuals. Nowadays, there is not an immune diagnostic method that can differentiate latent tuberculosis and tuberculosis disease. New studies have addressed some strategies including specific antibodies, new cytokines and / or antigens as candidates for biomarkers. However, the high costs of these studies, the low number of participants and their different methodology make difficult a future meta-analysis and more conclusive results., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)
- Published
- 2011
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18. Tetanus Quick Stick as an applicable and cost-effective test in assessment of immunity status.
- Author
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Hatamabadi HR, Abdalvand A, Safari S, Kariman H, Dolatabadi AA, Shahrami A, Alimohammadi H, and Hosseini M
- Subjects
- Adult, Cost-Benefit Analysis, Emergency Service, Hospital, Enzyme-Linked Immunosorbent Assay, Female, Humans, Male, Point-of-Care Systems economics, Reagent Strips economics, Sensitivity and Specificity, Tetanus prevention & control, Tetanus Toxoid immunology, Wounds and Injuries immunology, Immunologic Tests economics, Immunologic Tests instrumentation, Immunologic Tests methods, Tetanus immunology
- Abstract
Introduction: Tetanus vaccine and immunoglobulin administration are challenging decisions mostly because of the fact that the current protocol for immunization against tetanus is based on 2 variables: the vaccination status of the patient and the nature of wound and its exposure. To solve this problem, Tetanus Quick Stick (TQS; Nephrotek Laboratory, Rungis, France), an immunochromatographic dipstick test, was developed to determine the tetanus immunity of the patients. The aim of this present study was to investigate the sensitivity, specificity, and the positive and negative predictive values and cost-effectiveness of TQS in the emergency department (ED) setting., Methods: Blood samples were collected from 200 patients presenting to our ED. Information including demographic information, tetanus immunization status, wound description, and the preventive measures taken by the emergency physician were gathered by a preeducated nurse. Tetanus Quick Stick test and enzyme-linked immunosorbent assay were performed as the standard diagnostic test by an emergency physician and a laboratory technician, respectively; and results of the 2 techniques were compared., Result: Overall, tetanus vaccine was administered to 141(70.5%) patients and immunoglobulin to 105 (52.5%) patients. The analysis revealed 88.1% sensitivity and 97.6% specificity for the TQS test. The positive and negative predictive values of TQS test were 99.3% and 66.1%, respectively. Our analysis is also showed a significant decrease in cost when TQS was applied for patients with dirty, tetanus prone wounds or injuries and unknown or incomplete vaccination history (€ 9.48 versus € 12.1)., Conclusion: This study revealed TQS test to be appropriate and cost-effective for ED use especially in evaluating patients who do not remember or cannot give their tetanus immunization history., (Copyright © 2011 Elsevier Inc. All rights reserved.)
- Published
- 2011
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19. Cost-effectiveness of mass screening for colorectal cancer: choice of fecal occult blood test and screening strategy.
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Sobhani I, Alzahouri K, Ghout I, Charles DJ, and Durand-Zaleski I
- Subjects
- Aged, Colorectal Neoplasms diagnosis, Colorectal Neoplasms epidemiology, Cost-Benefit Analysis, Female, France epidemiology, Humans, Immunologic Tests methods, Incidence, Indicators and Reagents economics, Male, Mass Screening methods, Middle Aged, Models, Economic, Reproducibility of Results, Colonoscopy economics, Colorectal Neoplasms economics, Guaiac economics, Guidelines as Topic, Immunologic Tests economics, Mass Screening economics, Occult Blood
- Abstract
Background: Colorectal cancer is a major cause of mortality. This gives high public health priority to mass screening using a noninvasive, fecal occult blood test of asymptomatic individuals. A positive test selects those who should undergo colonoscopy to ensure early detection of colorectal cancer. Guaiac fecal occult blood test has low sensitivity. Automated immunochemical tests that measure the fecal human hemoglobin concentration are more sensitive and can be simplified as a 1- to 3-sample format with optimum cutoff points., Objective: The aim was to improve the sensitivity of the test by choosing an accurate format (1- to 3-sample and optimum hemoglobin concentration) while maintaining acceptable specificity and avoiding alteration of the screening program in terms of quality of life and economic outputs., Methods: We used a Markov model to estimate the cost-effectiveness of a screening program for a population of 100,000 asymptomatic individuals by use of immunological fecal tests with different cutoffs, leading to different sensitivity/specificity ratios, and to compare its incremental cost-effectiveness ratio compared with the guaiac fecal test program., Results: The results suggest that a 3-sample immunological test with 50 ng/mL as a positive cutoff is cost-effective. It provides more asymptomatic cancer detection without significantly increasing normal colonoscopies., Conclusion: This format should be prospectively evaluated in mass screening.
- Published
- 2011
- Full Text
- View/download PDF
20. Cost-effectiveness analysis of interferon-γ release assays versus chest X-ray for annual tuberculosis screening of healthcare workers.
- Author
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Kowada A, Deshpande GA, Takahashi O, Shimbo T, and Fukui T
- Subjects
- Adult, Cost-Benefit Analysis, Humans, Incidence, Latent Tuberculosis diagnosis, Latent Tuberculosis diagnostic imaging, Latent Tuberculosis epidemiology, Latent Tuberculosis immunology, Markov Chains, Middle Aged, Mycobacterium tuberculosis immunology, Tuberculosis, Pulmonary diagnostic imaging, Tuberculosis, Pulmonary epidemiology, Tuberculosis, Pulmonary immunology, Health Personnel, Immunologic Tests economics, Interferon-gamma biosynthesis, Mass Chest X-Ray economics, Mass Screening economics, Tuberculosis, Pulmonary diagnosis
- Published
- 2011
- Full Text
- View/download PDF
21. Utilization of the QuantiFERON-TB Gold test in a two-step process with the tuberculin skin test to evaluate health care workers for latent tuberculosis.
- Author
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Abdalhamid B, Hinrichs SH, Garrett JL, O'Neill JM, Hansen-Cain KM, Armbrust AA, and Iwen PC
- Subjects
- Adolescent, Adult, Algorithms, Bacteriological Techniques economics, Female, Humans, Immunologic Tests economics, Interferon-gamma metabolism, Male, Middle Aged, Sensitivity and Specificity, T-Lymphocytes immunology, Tuberculin immunology, Young Adult, Bacteriological Techniques methods, Health Personnel, Immunologic Tests methods, Latent Tuberculosis diagnosis
- Abstract
A cost analysis of combining a tuberculin skin test (TST) and the QuantiFERON-TB Gold test (QFT-GT) to detect latent tuberculosis in newly hired health care workers was performed. An approximately 50% reduction in the cost of additional care was realized when workers with positive TST results were subsequently screened using the QFT-GT.
- Published
- 2010
- Full Text
- View/download PDF
22. Cost effectiveness of interferon-gamma release assay versus chest X-ray for tuberculosis screening of BCG-vaccinated elderly populations.
- Author
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Kowada A, Deshpande GA, Takahashi O, Shimbo T, and Fukui T
- Subjects
- Aged, Aged, 80 and over, BCG Vaccine administration & dosage, Cost-Benefit Analysis, Female, Humans, Japan, Latent Tuberculosis diagnostic imaging, Latent Tuberculosis immunology, Male, Mass Screening economics, Tuberculosis, Pulmonary diagnostic imaging, Tuberculosis, Pulmonary immunology, Immunologic Tests economics, Interferon-gamma analysis, Interferon-gamma immunology, Latent Tuberculosis diagnosis, Mass Chest X-Ray economics, Tuberculosis, Pulmonary diagnosis
- Abstract
Background: The prevalence of tuberculosis (TB) in the elderly is higher than that in the general population, and elderly populations are considered a high-risk group. Currently, annual TB screening of Bacille Calmette-Guérin (BCG)-vaccinated people aged over 65 years is performed by an annual chest x-ray examination (CXR) in Japan. Interferon-gamma release assays (QuantiFERON-TB Gold and QuantiFERON-TB Gold In-Tube [QFT]) are new alternatives to the tuberculin skin test to diagnose latent TB infection (LTBI) that have no cross-reactivity with the BCG vaccine. We evaluated the cost effectiveness of QFT versus CXR versus no screening in BCG-vaccinated elderly populations., Methods: We constructed a Markov model to evaluate the cost effectiveness of QFT, CXR, and no screening. The target population was a hypothetical cohort of 1000 immunocompetent 65-year-olds, using a societal perspective and a lifetime horizon. All costs and clinical benefits were discounted at a fixed annual rate of 3%., Results: In the base-case analysis, a no-screening strategy resulted in the lowest cost ($US303.51; 14.6475 quality-adjusted life-years [QALYs]) compared with CXR ($US393.22; 14.6477 QALYs) and QFT ($US525.45; 14.6516 QALYs) [year 2008 values]. The sensitivity of QFT, as well as the prevalence of TB and LTBI, influenced the cost effectiveness; when the sensitivity of QFT was higher than 0.89, QFT became more cost effective than providing no screening. As the prevalence of LTBI and TB increased, the QFT strategy became progressively more cost effective., Conclusions: Providing no routine TB screening is currently the most cost-effective strategy for BCG-vaccinated elderly populations in Japan. There appears to be little role for CXR in TB screening of elderly populations. These findings may be applicable to other countries with intermediate and high TB risks when choosing optimal TB screening of elderly populations.
- Published
- 2010
- Full Text
- View/download PDF
23. Rational use of immunodiagnostic tools for tuberculosis infection: guidelines and cost effectiveness studies.
- Author
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Amicosante M, Ciccozzi M, and Markova R
- Subjects
- Antigens, Bacterial immunology, Cost-Benefit Analysis, Guidelines as Topic, Humans, Immunologic Tests methods, Interferon-gamma, Tuberculosis immunology, Tuberculosis, Pulmonary diagnosis, Tuberculosis, Pulmonary immunology, Immunologic Tests economics, Immunologic Tests standards, Mycobacterium tuberculosis immunology, Tuberculosis diagnosis
- Abstract
Tuberculosis (TB) remains a public health challenge and its control requires the use efficient diagnostic tools. Mycobacterium tuberculosis (MTB) elicits a strong immune response upon infection, a phenomenon measured by the old tuberculin skin test (TST). However, this test has many limitations and a high rate of positivity in BCG-vaccinated subjects. Recent studies have identified several MTB-antigens for diagnostic use, including the ESAT-6 and CFP-10 proteins. Based on these antigens, one of the most significant developments in the diagnostic armamentarium for TB has been the assays based on IFN- determination (IGRAs). The assays stem from the principle that T-cells of infected individuals produce IFN-gamma when they re-encounter the MTB antigens in vitro and this can be measured by a conventional ELISA test. The evaluation of IGRAs in different clinical settings showed many advantages over TST. The worldwide diffusion of IGRAs has increased the knowledge on their clinical use and a number of guidelines have been devised for their application. The two-step approach (first using TST followed by IGRA for confirmation) is the most favored strategy for IGRA-use in the general population, while the use of IGRAs alone is suggested in particular clinical settings and/or patient groups. Even if these tests are still costly there are a number of cost effective advantages in the "targeted" use of IGRAs over the TST. The work we present summarises all these aspects.
- Published
- 2010
24. Population screening for coeliac disease in primary care by district nurses using a rapid antibody test: diagnostic accuracy and feasibility study.
- Author
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Korponay-Szabó IR, Szabados K, Pusztai J, Uhrin K, Ludmány E, Nemes E, Kaukinen K, Kapitány A, Koskinen L, Sipka S, Imre A, and Mäki M
- Subjects
- Celiac Disease economics, Celiac Disease nursing, Child, Clinical Laboratory Techniques economics, Clinical Laboratory Techniques standards, Community Health Nursing economics, Cost-Benefit Analysis, Feasibility Studies, Humans, Immunoglobulin A blood, Immunoglobulin G blood, Immunologic Tests economics, Immunologic Tests methods, Immunologic Tests standards, Mass Screening economics, Treatment Outcome, Antibodies blood, Celiac Disease prevention & control, Community Health Nursing standards, Mass Screening methods
- Abstract
Objective: To evaluate the feasibility and diagnostic accuracy of screening for coeliac disease by rapid detection of IgA antibodies to tissue transglutaminase performed in primary care., Design: District nurses screened 6 year old children using rapid antibody testing of finger prick blood. They also collected capillary blood samples for laboratory determination of IgA and IgG antibodies to endomysium and IgA antibodies to tissue transglutaminase. Children with positive rapid test results were directly sent for biopsy of the small intestine. Setting Primary care in Jász-Nagykun-Szolnok county, Hungary., Participants: 2690 children (77% of 6 year olds living in the county) and 120 nurses., Main Outcome Measures: Positivity for antibodies to endomysium or transglutaminase in the laboratory and coeliac disease confirmed at biopsy., Results: 37 children (1.4%, 95% confidence interval 0.9% to 1.8%) had biopsy confirmed coeliac disease. Only five of these children had been diagnosed clinically before screening. Rapid testing had a 78.1% sensitivity (70.0% to 89.3%) and 100% specificity (88.4% to 100%) for a final diagnosis of coeliac disease by biopsy. Sensitivity was 65.1% (50.2% to 77.6%) and specificity was 100% (99.8% to 100%) compared with combined results of IgA and IgG laboratory tests. Trained laboratory workers detected 30 of the 31 newly diagnosed IgA competent patients with the rapid test kit used blindly. Median time to biopsy after a positive rapid test result was significantly shorter (20 days, range 4-148) than after a positive laboratory result (142 days, 70-256; P<0.001). Children with coeliac disease detected at screening were smaller and had worse health status than their peers but they improved on a gluten-free diet., Conclusions: A simple rapid antibody test enabled primary care nurses to detect patients with coeliac disease in the community who were not picked up in clinical care. Extra training is needed to improve sensitivity.
- Published
- 2007
- Full Text
- View/download PDF
25. Fertility clinics cashing in on risky immune tests, expert warns.
- Author
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Hopkin M
- Subjects
- Female, Humans, Immunologic Tests economics, Immunologic Tests ethics, Risk Factors, Ambulatory Care Facilities economics, Ambulatory Care Facilities ethics, Immunosuppressive Agents therapeutic use, Infertility, Female immunology, Infertility, Female therapy
- Published
- 2007
- Full Text
- View/download PDF
26. Application of a combined protocol for rational request and utilization of antibody assays improves clinical diagnostic efficacy in autoimmune rheumatic disease.
- Author
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Tampoia M, Brescia V, Fontana A, Zucano A, Morrone LF, and Pansini N
- Subjects
- Antigens, Nuclear immunology, Autoimmune Diseases blood, Autoimmune Diseases immunology, Cost-Benefit Analysis, DNA immunology, Humans, Immunologic Tests economics, Practice Guidelines as Topic, Rheumatic Diseases blood, Rheumatic Diseases immunology, Sensitivity and Specificity, Antibodies, Anti-Idiotypic blood, Antibodies, Antinuclear blood, Autoimmune Diseases diagnosis, Clinical Protocols, Immunologic Tests methods, Rheumatic Diseases diagnosis
- Abstract
Context: Because of a marked increase in the number of requests for antinuclear antibodies, anti-extractable nuclear antigen antibodies, and anti-double-stranded DNA antibodies for the diagnosis of autoimmune rheumatic disease, guidelines have been proposed for their appropriate use., Objective: To evaluate in terms of clinical efficacy and cost-benefit ratio the outcome of applying a protocol for the diagnosis of autoimmune rheumatic disease., Design: A diagnostic protocol for the rational utilization of second-level tests (anti-extractable nuclear antigen antibodies and anti-double-stranded DNA antibodies) was applied at Hospital Polyclinic beginning January 2004. The appropriateness of 685 consecutive requests received at the clinical pathology laboratory from January to June 2004 was assessed. Patients who underwent these laboratory tests were followed up for 12 months after blood sample drawing., Results: Introduction of the protocol led to a significant reduction in the number of second-level tests prescribed (27.9% vs 49.5% for anti-extractable nuclear antigen antibodies; 27.5% vs 56.6% for anti-double-stranded DNA antibodies). After the period of observation, none of the 163 patients who had negative results on the first-level test and were asymptomatic, for whom second-level tests had not therefore been performed, were found to have autoimmune rheumatic disease. In 90.5% (77/85) of patients positive for the second-level tests, clinical confirmation of autoimmune rheumatic disease was obtained., Conclusions: Not only did application of the diagnostic protocol reduce the number of second-level tests performed but it also increased their specificity. Our data thus indicate that the use of shared guidelines by clinical and laboratory specialists yields satisfactory results.
- Published
- 2007
- Full Text
- View/download PDF
27. Ensuring quality and access for malaria diagnosis: how can it be achieved?
- Author
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Bell D, Wongsrichanalai C, and Barnwell JW
- Subjects
- Antigens, Protozoan isolation & purification, Humans, Quality Control, Antigens, Protozoan analysis, Health Services Accessibility standards, Immunologic Tests economics, Immunologic Tests standards, Malaria diagnosis
- Abstract
The replacement of conventional antimalarial drugs with high-cost, artemisinin-based alternatives has created a gap in the successful management of malaria. This gap reflects an increased need for accurate disease diagnosis that cannot be met by traditional microscopy techniques. The recent introduction of rapid diagnostic tests (RDTs) has the potential to meet this need, but successful RDT implementation has been curtailed by poor product performance, inadequate methods to determine the quality of products and a lack of emphasis and capacity to deal with these issues. Economics and a desire for improved case management will result in the rapid growth of RDT use in the coming years. However, for their potential to be realized, it is crucial that high-quality RDT products that perform reliably and accurately under field conditions are made available. In achieving this goal, the shift from symptom-based diagnosis to parasite-based management of malaria can bring significant improvements to tropical fever management, rather than represent a further burden on poor, malaria-endemic populations and their overstretched health services.
- Published
- 2006
- Full Text
- View/download PDF
28. The routine use of high-resolution immunological screening of recipients of primary deceased donor kidney allografts is cost-effective.
- Author
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McLaughlin K, Manns B, and Nickerson P
- Subjects
- Cadaver, Canada, Cost-Benefit Analysis, Flow Cytometry, Humans, Kidney Transplantation economics, Life Expectancy, Treatment Outcome, Immunologic Tests economics, Kidney Transplantation immunology, Tissue Donors
- Abstract
Background: The economic and health benefits of kidney transplantation are dependent on the length of allograft survival. High-resolution immunological screening can identify recipients at increased risk of early graft loss caused by acute rejection, but the use of these tests increases screening costs before transplantation. The objective of this study was to evaluate the cost-effectiveness of routine use of high-resolution flow-cytometry cross-matching and solid-phase screening for all recipients of primary deceased donor kidney transplants., Methods: A Markov model was constructed to evaluate costs and effects of two different clinical strategies on a simulated cohort of 1,000 transplant recipients: serological screening (SS) only and flow screening (FS) only. Outcomes measures were total cost of patient care over 25 years, life expectancy, quality-adjusted life expectancy, and transplant life expectancy., Results: In the base-case analysis, FS was associated with an average gain of 0.08 life years, 0.25 transplant life years, and 0.08 quality-adjusted life years per patient. SS was associated with a higher cost of CND$6,397 per patient, mostly because of increased use of dialysis in patients who suffered early graft loss under the SS strategy. The results were robust to uncertainty in the majority of variables, and a strategy using FS was cost-effective except under the unlikely scenario where the false-negative rate for SS was
- Published
- 2006
- Full Text
- View/download PDF
29. Comparison of a monoclonal antigen stool test (Hp StAR) with the 13C-urea breath test in monitoring Helicobacter pylori eradication therapy.
- Author
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Perri F, Quitadamo M, Ricciardi R, Piepoli A, Cotugno R, Gentile A, Pilotto A, and Andriulli A
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Breath Tests, Helicobacter Infections drug therapy, Helicobacter Infections prevention & control, Humans, Immunologic Tests economics, Immunologic Tests standards, Male, Middle Aged, Monitoring, Physiologic, Sensitivity and Specificity, Urease metabolism, Antibodies, Monoclonal immunology, Antigens, Bacterial immunology, Feces chemistry, Helicobacter Infections diagnosis, Helicobacter pylori immunology, Immunologic Tests methods, Urea analysis
- Abstract
Aim: To evaluate the agreement between a mAb-based stool test (HP StAR) and the urea breath test (UBT) in monitoring (H pylori) infection after eradication therapy., Methods: Patients with discordant results on UBT and Hp StAR underwent endoscopy with biopsies for rapid urease test, culture, and histology to confirm H pylori status., Results: Among 250 patients (50+/-14 years), 240 (96.0%) had concordant UBT and Hp StAR tests with a significant correlation between DOB and A values (R = 0.87; P<0.0001). The remaining 10 (4.0%) patients had discordant tests (positive Hp StAR and negative UBT) with the Hp StAR inaccurate in five cases (false positive) and UBT inaccurate in the other five cases (false negative). The "maximal expected" sensitivity, specificity, +PV, -PV, +LR, and -LR were 91%, 100%, 100%, 97.4%, infinity, and 8.2 respectively, for the UBT, and 100%, 97.4%, 91%, 100%, 38.8, and 0, respectively, for the Hp StAR. Overall accuracy for both tests was 98%., Conclusion: Both the UBT and the Hp StAR are equally accurate in monitoring H pylori infection. Nowadays, the choice of the "best" non-invasive H pylori test in the post-treatment setting should be done not only in terms of diagnostic accuracy but also in view of cost and local facilities.
- Published
- 2005
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- View/download PDF
30. [What can be tested in a blood sample. Immunologic laboratory mice].
- Subjects
- Animals, Costs and Cost Analysis, Diagnosis, Differential, Family Practice economics, Female, Germany, Humans, Immunocompetence immunology, Immunologic Deficiency Syndromes economics, Immunologic Deficiency Syndromes immunology, Mice, Middle Aged, Naturopathy economics, Somatoform Disorders economics, Somatoform Disorders immunology, Unnecessary Procedures economics, Immunologic Deficiency Syndromes diagnosis, Immunologic Tests economics, Psychoneuroimmunology, Somatoform Disorders diagnosis
- Published
- 2005
31. The role of the clinical immunology laboratory in the diagnosis and monitoring of connective tissue diseases.
- Author
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Aziz KA and Faizal AA
- Subjects
- Autoimmune Diseases immunology, Connective Tissue Diseases immunology, Cost-Benefit Analysis, Diagnostic Errors economics, Follow-Up Studies, Health Resources economics, Humans, Predictive Value of Tests, Saudi Arabia, Antibodies, Antinuclear blood, Autoantibodies blood, Autoimmune Diseases diagnosis, Clinical Laboratory Techniques economics, Connective Tissue Diseases diagnosis, Immunologic Tests economics
- Abstract
Connective tissue diseases (CTD) are a group of autoimmune systemic diseases that can affect any organ-system in the body. The initial clinical presentations of these diseases overlap, not only with each other, but also with a wide range of other rheumatological and non-rheumatological disorders. Due to these reasons, clinicians depend heavily on the use of the clinical immunology laboratory for the diagnosis of CTD. A large number of tests exist in the laboratory for the investigation of CTD and each test can be performed by a number of different methods, each with its own limitations. Consequently, the significance of the results generated not only has to be interpreted in relation to the clinical picture, but also to the method used to generate the results. Moreover, within the laboratory, there is a hierarchical testing system for the investigation of CTD and if this system is used appropriately, in conjunction with the clinical picture, can result in the diagnosis/exclusion of CTD more efficiently and economically. In contrast, random use of the laboratory tests, combined with limited knowledge of the methods used to carry out these tests, can lead to delay or even misdiagnosis, as well as can lead to wastage of resources. In the following review, we have discussed the various tests that are used in the investigation of CTD, as well as the different methods used to carry out these tests, with the hope that such knowledge would lead to a more efficient and economical use of the clinical immunology laboratory in the investigation of CTD.
- Published
- 2004
32. A cost analysis of the use of the rapid, whole-blood, immunochromatographic P.f/P.v assay for the diagnosis of Plasmodium vivax malaria in a rural area of Sri Lanka.
- Author
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Fernando SD, Karunaweera ND, Fernando WP, Attanayake N, and Wickremasinghe AR
- Subjects
- Adolescent, Adult, Aged, Child, Child, Preschool, Chromatography economics, Chromatography methods, Costs and Cost Analysis methods, Female, Humans, Immunologic Tests economics, Immunologic Tests methods, Malaria, Vivax epidemiology, Male, Middle Aged, Prospective Studies, Rural Health, Sensitivity and Specificity, Sri Lanka epidemiology, Endemic Diseases economics, Malaria, Vivax diagnosis, Reagent Kits, Diagnostic economics
- Abstract
Between May 2001 and March 2002, a prospective study was conducted in a malaria-endemic area of Sri Lanka, to determine the cost implications of using the immunochromatographic P.f/P.v test to detect Plasmodium vivax infection. All consecutive subjects aged >5 years who presented with a history of fever were recruited. Each was checked for P. vivax infection by the standard microscopical examination of bloodsmears and by the immunochromatographic test (ICT). The costs of diagnosis using each method and the sensitivity, specificity and predictive values of the ICT (with bloodsmear examination used as the 'gold standard') were estimated, the costs/case detected being simulated for different slide positivity 'rates' and ICT sensitivities. In the detection of P. vivax, the ICT had a sensitivity of 70% and a specificity of 99%. The costs of the ICT per subject investigated and per case detected were, respectively, approximately 14 and 20 times more than those of bloodsmear examination. The costs of the ICT per case detected would fall as the sensitivity of the test increased. The ICT gave relatively few false-positive results. The current, relatively high cost of the ICT is the most important barrier to its routine operational use in the diagnosis of malaria. The test is already useful, however, in specific situations.
- Published
- 2004
- Full Text
- View/download PDF
33. Beyond antiretroviral access: low-cost laboratory tests needed for the developing world.
- Author
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Majchrowicz M
- Subjects
- Developing Countries, Diagnostic Tests, Routine economics, HIV Infections virology, Humans, Immunologic Tests economics, Anti-Retroviral Agents therapeutic use, HIV Infections drug therapy
- Published
- 2003
34. [The use of rapid tests for individual diagnosis of influenza].
- Author
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Uphoff H and Metzger C
- Subjects
- Antiviral Agents economics, Antiviral Agents therapeutic use, False Negative Reactions, False Positive Reactions, Humans, Immunologic Tests economics, Influenza, Human drug therapy, Influenza, Human economics, Neuraminidase antagonists & inhibitors, Office Visits economics, Reverse Transcriptase Polymerase Chain Reaction economics, Sensitivity and Specificity, Time Factors, Influenza, Human diagnosis
- Abstract
Antiviral therapy against influenza requires the beginning of treatment within 36 to 48 h after the onset of symptoms. With the availability of the neuraminidase inhibitors which are effective against influenza A and B a rapid diagnosis of influenza is of increasing interest. A diagnosis during the first consultation would be ideal for treatment. This can be achieved with clinical diagnosis and with quick tests that can be conducted in the practice (point of care test). The costs of such virological examinations have to be considered in relation to the use of information they create. The cost benefit relation is discussed in relation with different epidemic situations. The benefit and additional information of tests for individual diagnosis is high when the incidence of influenza is low, while in periods with high incidences the clinical diagnosis alone appears sufficient.
- Published
- 2002
- Full Text
- View/download PDF
35. Value of in vitro allergy testing.
- Author
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Keenan JM
- Subjects
- Cost-Benefit Analysis, Humans, Immunoglobulin E blood, Immunologic Tests economics, In Vitro Techniques, Sensitivity and Specificity, Skin Tests, Hypersensitivity diagnosis, Immunologic Tests methods, Primary Health Care methods
- Published
- 2002
36. Diagnosis of lupus: a glass half full.
- Author
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Clough JD
- Subjects
- Biomarkers analysis, Diagnosis, Differential, Diagnostic Errors economics, Fibromyalgia diagnosis, Humans, Immunologic Tests economics, Antibodies, Antinuclear analysis, Immunologic Tests standards, Lupus Erythematosus, Systemic diagnosis
- Published
- 2002
- Full Text
- View/download PDF
37. A comparison study of different methods used in the detection of Giardia lamblia.
- Author
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Aziz H, Beck CE, Lux MF, and Hudson MJ
- Subjects
- Animals, Costs and Cost Analysis, Enzyme-Linked Immunosorbent Assay economics, Fluorescent Antibody Technique, Direct economics, Humans, Immunoenzyme Techniques economics, Sensitivity and Specificity, Feces parasitology, Giardia lamblia isolation & purification, Giardiasis diagnosis, Immunologic Tests economics
- Abstract
Objective: The purpose of this study was to compare results obtained using a single fecal specimen for O&P examination, direct immunofluorescent assay (DFA), and three immunodiagnostic techniques., Design: Sixty-eight human fecal specimens were collected and examined by each method. The O&P and the DFA were used as the reference method., Setting: The study was performed at the research laboratory in the Medical Technology Department at The University of Southern Mississippi., Patients or Other Participants: The fecal specimens were collected from individuals with a suspected Giardia lamblia infection., Interventions: None., Main Outcome Measures: The amount of agreement and disagreement between methods. 1. The sensitivity and specificity of each method. 2. The working time and cost per specimen for each method., Results: There was complete agreement among methods on 52 specimens (21 positive, 31 negative). Eight specimens were positive by all immunologic methods, but negative by O&P. The remaining eight specimens (12%) demonstrated discrepancies among methods. Sensitivity and specificity of each assay ranged from 91% to 100% and 89% to 100%, respectively. The cost per specimen ranged from $11.62 for the DFA method to $32.54 for the O&P method. The average cost per specimen for ELISA and EIA averaged $26.86., Conclusion: The study supported findings of other investigators who concluded that immunologic methods have the greater sensitivity. The immunologic methods were more efficient, quicker, and economical than the conventional O&P method.
- Published
- 2001
38. Prevalence of hepatitis A virus and hepatitis B virus immunity in patients with polymerase chain reaction-confirmed hepatitis C: implications for vaccination strategy.
- Author
-
Siddiqui F, Mutchnick M, Kinzie J, Peleman R, Naylor P, and Ehrinpreis M
- Subjects
- Adult, Aging immunology, Black People, Cost-Benefit Analysis, Female, Humans, Immunologic Tests economics, Male, Middle Aged, Polymerase Chain Reaction, Risk Factors, Vaccination economics, Black or African American, Hepatitis B virus immunology, Hepatitis B virus isolation & purification, Hepatitis C, Chronic immunology, Hepatitis C, Chronic virology, Hepatovirus isolation & purification, Immunity
- Abstract
Objectives: Administration of vaccine for hepatitis A virus (HAV) and hepatitis B virus (HBV) is recommended for patients with chronic hepatitis C (CHC) because of the potential for increased severity of acute hepatitis superimposed on existing liver disease. The aim of this study is to determine the prevalence of antibodies directed against HAV and HBV in patients with CHC, analyze demographic and risk factors associated with this prevalence, and develop a cost-effective vaccination strategy., Methods: We reviewed records from 1092 CHC patients. Demographics and information regarding risk factors were obtained by history and questionnaire administered to all patients. The costs of vaccination and antibody testing were determined, based on standard laboratory and clinic charges at our institution. HAV and HBV markers were correlated to race, age, and risk factors., Results: Of the total population studied (n = 1092), 72% were African-Americans, 27% white, and 1% others. Of 671 CHC patients tested for anti-HAV IgG, 252 (38%) were positive. Of 743 CHC patients tested for HBV antibodies (anti-hepatitis B core IgG or anti-hepatitis B surface), 494 (67%) were positive. African-Americans are more likely to have antibodies to HAV and HBV (67% and 75%, respectively) compared to whites (27% and 20%). The prevalence of anti-HAV was 76% in patients >60 yr, 34% in the 40- to 60-yr-old age group, and 21% in patients <40 yr. The highest prevalence of HBV antibodies was found in patients between the ages of 40-60 yr. No HCV risk factors were associated with increased HAV risk. In CHC patients with HBV antibodies, however, illicit injection drug use was the predominant risk factor., Conclusions: The prevalence of anti-HAV in patients with CHC was found to be similar to that of the general population in the United States (33% according to recent Centers for Disease Control data), consistent with the hypothesis that the two infections do not share risk factors. Because the prevalence of HAV immunity is low in CHC patients <40 yr, empiric HAV vaccination is cost effective. If two doses of vaccine are to be given, however, antibody testing of all HCV patients is indicated. In the subset of patients >60 yr of age or who are African-American, where the prevalence of HAV exposure is considerably higher, it would be cost effective to check the antibody ($36.00), before vaccination ($97.00). The prevalence of HBV antibodies, however, is significantly increased in patients with CHC compared with the general population (5.3% per the Centers for Disease Control), likely as a result of exposure to similar parenteral risk factors. HBV antibody testing ($26.00 per test) should, therefore, be undertaken in all CHC patients who are hepatitis B surface antigen negative, as this approach is cost-effective compared to empiric HBV vaccination ($438.00 for a three injection course).
- Published
- 2001
- Full Text
- View/download PDF
39. Workload generated by a living donor programme for renal transplantation.
- Author
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Saunders RN, Elwell R, Murphy GJ, Horsburgh T, Carr SJ, and Nicholson ML
- Subjects
- Health Care Costs, Humans, Immunologic Tests economics, Patient Dropouts statistics & numerical data, Referral and Consultation statistics & numerical data, Retrospective Studies, Kidney Transplantation immunology, Living Donors statistics & numerical data, Workload statistics & numerical data
- Abstract
Background: The ethical and medical implications of live kidney donation result in a comprehensive work-up process. The aim of this study was to determine the magnitude of the workload and the yield of renal transplants generated by a live donor programme., Methods: Referrals to the Leicester live donor programme over the five-year period 1994-1998 were retrospectively assessed. These were initiated by nephrology referral and subsequently investigated in a stepwise manner. Patients were counselled and baseline tests performed prior to consultant surgeon review and assessment of donor renal function/anatomy., Results: One hundred and fifty referrals consisting of 150 recipients with 269 potential donors were originally made. This resulted in 32/120 (27%) related and 3/30 (10%) unrelated recipients (P=0.06) and 32/220 (15%) related and 3/49 (6%) unrelated donors proceeding to live donor transplantation, with a mean work-up time (+/-SD) of 9 (+/-7) months. One hundred and fifteen recipients (77%) and 234 (87%) donors failed to proceed at various stages of assessment, for a variety of immunological, medical and social reasons. A large number of expensive immunological investigations were required for potential donors, the majority of which did not proceed to transplantation. However as a result of performing these in the early stages of assessment the number of more invasive tests is kept to a minimum., Conclusions: There is a relatively low yield of transplants from live donor referrals, particularly those between unrelated individuals. The vast majority of referrals fail to proceed for legitimate reasons, but as a result, create a significant workload with notable staffing and financial implications.
- Published
- 2000
- Full Text
- View/download PDF
40. [Increasing use of laboratory tests--a controllable process?].
- Author
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Ulvestad E
- Subjects
- Diagnostic Tests, Routine economics, Diagnostic Tests, Routine statistics & numerical data, Efficiency, Organizational, Humans, Immunologic Tests economics, Immunologic Tests statistics & numerical data, Laboratories economics, Microbiological Techniques economics, Microbiological Techniques statistics & numerical data, Norway, Quality Assurance, Health Care, Laboratories statistics & numerical data
- Published
- 2000
41. A comparison of three malaria diagnostic tests, under field conditions in North-west Thailand.
- Author
-
Stephens JK, Phanart K, Rooney W, and Barnish G
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Antigens, Protozoan analysis, Child, Child, Preschool, Cost-Benefit Analysis, Female, Hemoglobinometry, Humans, Infant, Infant, Newborn, Male, Medical History Taking, Microscopy, Middle Aged, Sensitivity and Specificity, Thailand, Immunologic Tests economics, Malaria, Falciparum diagnosis, Reagent Kits, Diagnostic economics
- Abstract
A hospital-based trial to compare the clinical diagnosis of malaria; microscopy, and a rapid diagnostic antigen capture detection dipstick (ParaSight-F) was conducted in North-west Thailand. 301 people who presented themselves at the hospital were selected. 204 (68%) were presumptively diagnosed as having malaria by the triage nurses; 64 (21.3%) were P. falciparum parasite positive, and 94 (32%) tested positive for P. falciparum with the ParaSight-F test strips. There was no association between hemoglobin levels (<10g/dl and > or = 10g/dl) and malaria, and although there was a good statistical association between temperature and malaria the specificity, sensitivity and positive predictive values were all low, indicating that temperature alone is a poor indicator of the disease. Based on the microscopy results, we found that a presumptive clinical diagnosis dramatically over-diagnosed malaria, and similarly there were a large number of false positives using the ParaSight-F test. We believe that many of the patients had received some form of malaria treatment prior to presentation at the hospital, and that the high number of false positives are explained by persistent antigenemia and the possibility of there being sequestered parasites following incomplete chemotherapy.
- Published
- 1999
42. A new method with general diagnostic utility for the calculation of immunoglobulin G avidity.
- Author
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Korhonen MH, Brunstein J, Haario H, Katnikov A, Rescaldani R, and Hedman K
- Subjects
- Antibodies, Protozoan analysis, Antibodies, Protozoan immunology, Antibodies, Viral analysis, Antibodies, Viral immunology, Antibody Specificity, Cost-Benefit Analysis, Cytomegalovirus Infections diagnosis, Cytomegalovirus Infections immunology, Epstein-Barr Virus Infections diagnosis, Epstein-Barr Virus Infections immunology, Humans, Immunologic Tests economics, Immunologic Tests standards, Logistic Models, Parvoviridae Infections diagnosis, Parvoviridae Infections immunology, Reference Standards, Rubella diagnosis, Rubella immunology, Titrimetry, Toxoplasmosis diagnosis, Toxoplasmosis immunology, Virus Diseases immunology, Antibody Affinity, Immunoglobulin G analysis, Immunoglobulin G immunology, Immunologic Tests methods, Virus Diseases diagnosis
- Abstract
The reference method for immunoglobulin G (IgG) avidity determination includes reagent-consuming serum titration. Aiming at better IgG avidity diagnostics, we applied a logistic model for the reproduction of antibody titration curves. This method was tested with well-characterized serum panels for cytomegalovirus, Epstein-Barr virus, rubella virus, parvovirus B19, and Toxoplasma gondii. This approach for IgG avidity calculation is generally applicable and attains the diagnostic performance of the reference method while being less laborious and twice as cost-effective.
- Published
- 1999
- Full Text
- View/download PDF
43. Autoantibody screening for infertility: explaining the unexplained?
- Author
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Hatasaka HH, Branch DW, Kutteh WH, and Scott JR
- Subjects
- Abortion, Habitual immunology, Abortion, Habitual therapy, Antiphospholipid Syndrome diagnosis, Disease Management, Female, Fertilization immunology, Fertilization in Vitro, Humans, Infertility, Female immunology, Infertility, Female therapy, Predictive Value of Tests, Pregnancy, Abortion, Habitual etiology, Autoantibodies analysis, Immunologic Tests economics, Infertility, Female etiology, Phospholipids immunology
- Abstract
Several laboratories currently offer panels of serum autoantibody assays to screen women with unexplained infertility and those undergoing in vitro fertilization (IVF). Offering these tests implies that they have predictive value for the outcome of proposed infertility treatments such that the results of the testing would alter clinical management. Because screening for antiphospholipid antibodies adds expense to already costly procedures, it is an appropriate time to review the justification for the use of these panels.
- Published
- 1997
- Full Text
- View/download PDF
44. [Cost-effective approach to the screening of HIV, HBV, HCV, HTLV in blood donors in France].
- Author
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Sailly JC, Lebrun T, and Coudeville L
- Subjects
- Blood Transfusion standards, Cost-Benefit Analysis, France, HIV isolation & purification, Health Expenditures, Hepacivirus isolation & purification, Hepatitis B virus isolation & purification, Human T-lymphotropic virus 1 isolation & purification, Human T-lymphotropic virus 2 isolation & purification, Humans, Immunologic Tests economics, Male, Blood virology, Blood Transfusion economics
- Abstract
In order to provide greater safety in blood transfusions, public health authorities have imposed the use of screening tests. The purpose of this paper is to estimate the cost-effectiveness ratios of the screening test used in France. Four risks were studied: HIV, HBV, HCV and HTLV. Two efficiency measures were used: cost per positive blood donation detected and cost per case of prevented infection transmission. Moreover, for HTLV alone, the efficiency was estimated by the cost per prevented pathology. Data concerning the costs were provided by the French Blood Agency; those concerning the results of the screening campaigns were provided by the official health authorities, the other data used in the calculations were drawn either from the French Blood Agency data or from a review of international literature. Results gave information about the expenditure devoted to the screening of virologic risks associated with blood transfusion in France (250 million francs per year for the four viruses studied). They stressed the differences in screening efficiency according to the test studied (the cost by prevented seroconversion varied from 31,795 francs for HBV, 72,180 francs for HCV, 676,596 francs for HIV to 6,137,346 francs for HTLV screening test in the base case) and especially the very low efficiency of the systematic screening of the HTLV virus (from 34 to 307 million francs per prevented leukemia).
- Published
- 1997
45. The prevalence and direct costs of pre-immunization testing for hepatitis A in general practice.
- Author
-
Buckley D, Fahey T, and Bevan G
- Subjects
- Adolescent, Adult, Child, Child, Preschool, Cost-Benefit Analysis, Hepatitis A epidemiology, Hepatitis A prevention & control, Humans, Immunologic Tests economics, Infant, Middle Aged, Prevalence, Vaccination economics, Viral Hepatitis Vaccines, Hepatitis A immunology, Hepatitis Antibodies blood
- Abstract
Two hundred and twenty patients in one general practice travelling to destinations where immunization against hepatitis A virus (HAV) is recommended were tested for their HAV immune status before immunization. Age-specific prevalence of prior immunity to HAV was estimated. The relative costs of pre-immunization testing and immediate immunization were compared. The most cost-effective testing method for this practice was found to be total population testing prior to immunization with HAV vaccine. Individual general practices can estimate the optimal age at which to commence testing for HAV in their own practice population.
- Published
- 1996
46. Management of the presumed susceptible varicella (chickenpox)-exposed gravida: a cost-effectiveness/cost-benefit analysis.
- Author
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Rouse DJ, Gardner M, Allen SJ, and Goldenberg RL
- Subjects
- Adult, Chickenpox diagnosis, Chickenpox mortality, Cost-Benefit Analysis, Decision Support Techniques, Disease Susceptibility, Female, Herpesvirus 3, Human immunology, Hospitalization economics, Humans, Immunization, Passive economics, Immunologic Tests economics, Pregnancy, Pregnancy Complications, Infectious diagnosis, Pregnancy Complications, Infectious mortality, Risk Factors, Value of Life, Chickenpox economics, Chickenpox prevention & control, Pregnancy Complications, Infectious economics, Pregnancy Complications, Infectious prevention & control
- Abstract
Objective: To compare the cost-effectiveness and cost-benefit of different strategies for managing the presumed susceptible varicella (chickenpox)-exposed gravida., Methods: Three strategies were evaluated: 1) a do-nothing or observation strategy; 2) a testing strategy, in which immune status was assessed and varicella-zoster immune globulin was administered to those who tested nonimmune; and 3) a universal-administration strategy, in which varicella-zoster immune globulin was given to all exposed, presumed susceptible gravidas. Because precise data are unavailable about varicella mortality and hospitalization rates in pregnancy, a range of potential rates was evaluated, from one to greater than 20 times healthy nonpregnant adult rates. The potential efficacy of varicella-zoster immune globulin varied from 1 to 99%. A strategy was defined as cost-effective if it cost less than $50,000 per life-year gained., Results: If the mortality rate from varicella infection in pregnancy was increased fivefold over the nonpregnant healthy adult rate (ie, from 31/100,000 to 155/100,000 cases), efficacy would have to be at least 49% for the immune-testing strategy to be cost-effective. If pregnancy only doubled the varicella mortality rate, then even with perfect efficacy, the immune-testing strategy would not be cost-effective. Under most assumptions, the universal-administration strategy was cost-ineffective when compared with the immune-testing strategy. Similar results were obtained in the parallel cost-benefit analysis, which considered hospitalization costs and rates. The analysis was sensitive to the varicella transmission rate and the discount rate., Conclusion: From a cost-effectiveness/cost-benefit standpoint, management based on immune testing is preferable to universal varicella-zoster immune globulin administration when caring for the varicella-exposed gravida with a negative or indeterminate infection history.
- Published
- 1996
- Full Text
- View/download PDF
47. Immunotechnological products in adverse global environments.
- Author
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Arya SC
- Subjects
- Developing Countries, Humans, Immunologic Tests economics, Immunologic Tests trends, Immunologic Techniques economics, Immunologic Techniques trends
- Published
- 1995
- Full Text
- View/download PDF
48. Thoughts on matrix effects in immunological analysis.
- Author
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Bergmeyer HU
- Subjects
- Costs and Cost Analysis, Humans, Immunologic Tests economics, Immunologic Tests instrumentation, Materials Testing economics, Materials Testing methods, Immunologic Tests methods
- Published
- 1995
- Full Text
- View/download PDF
49. Cost-effectiveness of various methods of diagnosing hypersensitivity to Alternaria.
- Author
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Escudero AI, Sánchez-Guerrero IM, Mora AM, Soriano V, López JD, García FJ, Negro JM, Hernández J, and Pagán JA
- Subjects
- Adolescent, Adult, Asthma etiology, Bronchial Provocation Tests economics, Child, Child, Preschool, Conjunctivitis, Allergic etiology, Cost-Benefit Analysis, Enzyme-Linked Immunosorbent Assay economics, Female, Humans, Male, Middle Aged, Nasal Provocation Tests economics, Plant Extracts, Radioallergosorbent Test economics, Rhinitis, Allergic, Perennial etiology, Sensitivity and Specificity, Skin Tests economics, Alternaria immunology, Asthma diagnosis, Immunologic Tests economics, Rhinitis, Allergic, Perennial diagnosis
- Abstract
This study was undertaken for two reasons: 1) It is more difficult to diagnose hypersensitivity to molds than to other allergens, so an evaluation of diagnostic tests was needed. 2) Alternaria is the principal cause of mold sensitization in our area. Sixty-six patients (20 +/- 4 years) were selected and divided into two groups. Group A was made up of patients with rhinitis and/or asthma due to Alternaria sensitization. Group B consisted of patients sensitized to other allergens and patients with nonrespiratory allergic disorders. Skin tests (prick and intradermal), challenge tests (conjunctival, nasal, and bronchial), and specific IgE determination were performed for all patients. A biologically standardized extract of Alternaria tenuis (Alergia e Inmunología Abelló, S. A., Madrid, Spain) obtained from a single batch was used for all tests. Our diagnostic criterion was a clinical history of rhinitis or asthma that coincided with the results of nasal/bronchial challenge. The diagnostic value of the other tests was compared to this criterion. In the group of rhinitic patients, skin tests and conjunctival challenge were more sensitive than specific IgE determination. In asthmatic patients, the most sensitive techniques were nasal and conjunctival challenges, followed by prick and intradermal skin tests, and, lastly, serum specific IgE determination. When rhinitis and asthma were considered jointly, the most sensitive test was conjunctival challenge, followed by skin-prick and intradermal tests. All tests had the same specificity, regardless of disorder. Nasal challenge was positive in all patients. Skin tests are easy to perform, cheap, non-traumatic for the patient, and sufficiently specific and sensitive for the diagnosis of Alternaria hypersensitivity.(ABSTRACT TRUNCATED AT 250 WORDS)
- Published
- 1993
50. [Cost-benefit relationship of serologic studies in autoimmune diseases].
- Author
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Grob PJ, Joller-Jemelka HI, Scheitlin T, and Dubs RW
- Subjects
- Autoimmune Diseases economics, Autoimmune Diseases immunology, Cost-Benefit Analysis, Humans, Autoimmune Diseases diagnosis, Immunologic Tests economics
- Abstract
Autoimmune disorders are mainly clinically defined disease entities. The diagnosis of many of the systemic autoimmunopathies is based on characteristic combinations of symptoms, some of them overlapping various kinds and being of unspecific nature. Therefore, laboratory parameters such as autoantibodies, components of the complement system, some cytokines and their receptors, etc., are used for the diagnosis, although many of them are of limited specificity and sensitivity. The most important immunoparameters being of value for diagnosis and disease monitoring are discussed, and a stepwise procedure is proposed in order to reduce the costs. Basis are the screening tests for antinuclear antibodies (ANA) and for antibodies against cytoplasmatic components of granulocytes (ANCA). Depending on more specific questions, other tests and test combinations are then applied in second and third priorities.
- Published
- 1993
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