Comparative cost-effectiveness of two-tiered testing strategies for serodiagnosis of lyme disease with noncutaneous manifestations.
The mainstay of laboratory diagnosis for Lyme disease is two-tiered serological testing, in which a reactive first-tier enzyme-linked immunosorbent assay (ELISA) or an immunofluorescence assay is supplemented by separate IgM and IgG immunoblots. Recent data suggest that the C6 ELISA can be substituted for immunoblots without a reduction in either sensitivity or specificity. In this study, the costs of 4 different two-tiered testing strategies for Lyme disease were compared using the median charges for these tests at 6 commercial diagnostic laboratories in 2012. The study found that a whole-cell sonicate ELISA followed by the C6 ELISA was the most cost-effective two-tiered testing strategy for Lyme disease with acute-phase serum samples. We conclude that the C6 ELISA can substitute for immunoblots in the two-tiered testing protocol for Lyme disease without a loss of sensitivity or specificity and is less expensive.
Division of Infectious Diseases, New York Medical College, Valhalla, New York, USA.
Gary P
GP
Wormser
Andrew
A
Levin
Sandeep
S
Soman
Omosalewa
O
Adenikinju
Michael V
MV
Longo
John A
JA
Branda
D003362:Cost-Benefit Analysis; D004797:Enzyme-Linked Immunosorbent Assay / Q000191:economics / Q000379:methods; D005455:Fluorescent Antibody Technique / Q000191:economics / Q000379:methods; D006801:Humans; D015151:Immunoblotting / Q000191:economics / Q000379:methods; D008193:Lyme Disease / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D012698:Serologic Tests / Q000191:economics / Q000379:methods