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

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.

摘要 引言：巴西的人类T淋巴细胞病毒1型/2型（HTLV-1/-2）感染者数量位居全球首位。HTLV-1相关疾病具有较高的发病率与死亡率，尤其是在婴幼儿时期感染后，亟需采取有力措施以降低病毒垂直传播风险。
研究方法：为协助巴西卫生部评估HTLV产前筛查项目的实施情况，本研究根据HTLV血清阳性率、筛查试验的特异性以及确证试验的类型，测算不同场景下的项目成本。
研究结果：HTLV产前筛查的年度成本为55,777,012至77,082,123雷亚尔（R$）。采用高特异性的筛查试验，可将确证试验的需求与成本最高降低25%。
研究结论：需审慎选择筛查试验，以优化该项目的实施效果。