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Lyme Disease Testing by Large Commercial Laboratories in the United States
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9 1 2014
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Source: Clin Infect Dis. 59(5):676-681
[PDF-115.72 KB]
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Alternative Title:Clin Infect Dis
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Description:Background
Laboratory testing is helpful when evaluating patients with suspected Lyme disease (LD). A two-tiered antibody testing approach is recommended, but single-tier and non-validated tests are also used. We conducted a survey of large commercial laboratories in the United States to assess laboratory practices. We used these data to estimate the cost of testing and number of infections among patients from whom specimens were submitted.
Methods
Large commercial laboratories were asked to report the type and volume of testing conducted nationwide in 2008, as well as the percent of positive tests for four LD endemic states. The total direct cost of testing was calculated for each test type. These data and test-specific performance parameters available in published literature were used to estimate the number of infections among source patients.
Results
Seven participating laboratories performed ~3.4 million LD tests on ~2.4 million specimens nationwide at an estimated cost of $492 million. Two-tiered testing accounted for at least 62% of assays performed; alternative testing accounted for less than 3% of assays. The estimated frequency of infection among patients from whom specimens were submitted ranged from 10% to 18.5%. Applied to the total numbers of specimens, this yielded an estimated 240,000 to 444,000 infected source patients in 2008.
Discussion
LD testing is common and costly, with most testing in accordance with diagnostic recommendations. These results highlight the importance of considering clinical and exposure history when interpreting laboratory results for diagnostic and surveillance purposes.
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Pubmed ID:24879782
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Pubmed Central ID:PMC4646413
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