title: Effective management of hepatitis C molecular testing improves test use without compromising patient management.
abstract: BACKGROUND
  The availability of effective antiviral therapy for hepatitis C has increased the need for molecular detection and quantification of circulating hepatitis C viral particles. The limits of detection differ for the quantitative and qualitative reverse transcriptase polymerase chain reaction (RT-PCR) assays; furthermore, adequate patient assessment requires both detection of hepatitis C virus when it is present and quantitation of the viral load when possible. The combination of these factors promotes the simultaneous ordering of both tests with the possibility of generating redundant test information.
  
  
  OBJECTIVE
  To reduce the number of unnecessary hepatitis C tests performed.
  
  
  METHODS
  We established a reflexive testing protocol for quantitative and qualitative RT-PCR testing for hepatitis C.
  
  
  RESULTS
  During a 3(1/2)-month interval, 170 qualitative RT-PCR hepatitis C tests were eliminated (a 59.4% reduction in the number of these tests). This reduction was achieved without a clinically significant change in turnaround time or a compromise of patient care.
  
  
  CONCLUSIONS
  Establishing the quantitative and qualitative RT-PCR tests in-house and adopting the reflexive testing protocol was cost-effective and did not compromise patient management or care.
authors.affiliation: Division of Molecular Pathology, Department of Pathology, Saint Louis University School of Medicine, Saint Louis, MO 63104, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Kukuczka
authors.forename: Leonard E
authors.initials: LE
authors.lastname: Grosso
mesh_terms: D016174:Hepacivirus / Q000235:genetics* / Q000302:isolation & purification; D006526:Hepatitis C / Q000175:diagnosis* / Q000821:virology; D006801:Humans; D020133:Reverse Transcriptase Polymerase Chain Reaction; D019562:Viral Load