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Journal of Clinical Microbiology, January 1998, p. 94-99, Vol. 36, No. 1
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.

Comparison of Performance and Cost-Effectiveness of Direct Fluorescent-Antibody, Ligase Chain Reaction, and PCR Assays for Verification of Chlamydial Enzyme Immunoassay Results for Populations with a Low to Moderate Prevalence of Chlamydia trachomatis Infection

Deborah Dean,1,* Dennis Ferrero,2 and Michael McCarthy3

Departments of Medicine and the Francis I. Proctor Foundation, University of California at San Francisco School of Medicine, San Francisco,1 and San Joaquin County Regional Public Health Laboratory, Stockton,2 California, and Diagnostic Laboratory, Auckland, New Zealand3

Received 4 August 1997/Returned for modification 12 September 1997/Accepted 10 October 1997

Many laboratories use a commercial enzyme immunoassay (EIA) with verification testing to diagnose Chlamydia trachomatis infections in an effort to contain costs. This study was designed to compare the performance and cost-effectiveness of direct fluorescent-antibody assay (DFA), commercial PCR, and ligase chain reaction (LCR) for the verification of EIA results. Cervical specimens were screened by EIA. DFA, PCR, and LCR were compared as verification tests for EIA-reactive specimens and negative greyzone (NGZ) specimens at 50% below the cutoff value. These samples were also tested by in-house PCR, which was used in the analysis of verification results. A total of 477 (7%) of 6,571 samples were reactive or within the NGZ. EIA results with verification by DFA testing (EIA/DFA results) agreed with 93% of the true results compared with 97% for EIA/PCR results for one set of 242 samples; there was 97% agreement with true results for EIA/DFA results versus 95% for EIA/LCR results for another set of 235 samples. Ten samples were false positive by LCR. Time and costs were equivalent for EIA with the DFA, PCR, or LCR as the verification test but were two- to threefold greater for PCR or LCR alone than for EIA with verification. Since it is important to balance cost containment with public health objectives, DFA, PCR, and LCR as EIA verification tests for cervical samples offer acceptable sensitivities and specificities at reasonable cost for low- to moderate-risk populations and therefore can be extended to a broader spectrum of at-risk populations.

* Corresponding author. Mailing address: University of California at San Francisco School of Medicine, Box 0412, S-307, 513 Parnassus Ave., San Francisco, CA 94143-0412. Phone: (415) 476-4548. Fax: (415) 476-6085. E-mail: debd{at}itsa.ucsf.edu.

Journal of Clinical Microbiology, January 1998, p. 94-99, Vol. 36, No. 1
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.


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