Specificity of HTLV screening tests and its impact on health care program costs: The perspective of antenatal screening in Brazil

Rosadas, Carolina; Caterino-de-Araujo, Adele; Taylor, Graham Philip

doi:10.1590/0037-8682-0853-2020

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Revista da Sociedade Brasileira de Medicina Tropical

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Sumário

Short Communication • Rev. Soc. Bras. Med. Trop. 54 • 2021 • https://doi.org/10.1590/0037-8682-0853-2020 copy

Specificity of HTLV screening tests and its impact on health care program costs: The perspective of antenatal screening in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

INTRODUCTION:

Brazil ranks first in the number of HTLV-1/-2-infected individuals worldwide. The high morbidity and mortality of HTLV-1-associated diseases, especially following infection in infancy, requires strong action to reduce vertical transmission.

METHODS:

To facilitate the appraisal of the implementation of the HTLV antenatal screening program by the Brazilian Ministry of Health, we determined the costs in distinct scenarios according to HTLV seroprevalence, specificity of the screening test, and type of confirmatory test.

RESULTS:

HTLV antenatal screening would cost R$ 55,777,012-R$ 77,082,123/year. Screening assays with high specificity reduce the need and cost of confirmatory assays by up to 25%.

CONCLUSIONS:

Careful selection of the screening assay is required to optimize the program.

Keywords:
Human T cell lymphotropic virus (HTLV); Diagnosis; Screening assays; Specificity; Antenatal care program; Cost-effectiveness

Assay specificity	Positive in HTLV screening test			Cost of confirmatory assay^a		Total cost of antenatal screening^a
	HTLV-1 infected (expected n)	False positive (expected n)	Total positive screening (n)	WB (R$)	PCR (R$)	ELISA + WB (R$)	ELISA + PCR (R$)
0.1% HTLV prevalence
92.0%	2,945	235,300	238,245	20,250,825	15,485,925	74,879,313	70,114,414
98.1%	2,945	55,954	58,899	5,006,384	3,828,412	59,634,873	58,456,900
99.0%	2,945	29,449	32,394	2,753,511	2,105,626	57,382,000	56,734,115
99.5%	2,945	14,725	17,670	1,501,915	1,148,523	56,130,404	55,777,012
1.05% HTLV prevalence
92.0%	30,922	233,239	264,160	22,453,634	17,170,426	77,082,123	71,798,915
98.1%	30,922	55,365	86,287	7,334,353	5,608,623	61,962,842	60,237,112
99.0%	30,922	26,504	57,426	4,881,225	3,732,701	59,509,713	58,361,190
99.5%	30,922	14,430	45,352	3,854,916	2,947,877	58,483,405	57,576,366

	Maximum savings^a (R$)		Cost minimization^a (%)
	ELISA + WB	ELISA + PCR	ELISA + WB	ELISA + PCR
0.1% prevalence	18,748,909	14,337,402	25.0	20.4
1.05% prevalence	18,598,718	14,222,549	24.1	19.8

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[1] Corresponding author: Dra. Carolina Rosadas. e-mail:crosadas@imperial.ac.uk