- Email: [email protected]
Acceptance, Yield and Feasibility of Attaching HCV Birth Control Screening to Colorectal Cancer Screening in Spain
POSTER PRESENTATIONS infection were referred to local health services according to established NHS arrangements and outcomes of were collected 12 months after referral date. Results: 491 individuals were included in the final analysis. Study population was predominantly male (89%), aged between 30 and 49 (52%), UK born (62%) and 90% been homeless for longer than one year. Over half (55%) had spent time in prison and 18% were currently injecting either crack cocaine or heroin. The overall prevalence of current Hep C was 13.0% (95%CIs: 10.0, 16.0), past or current Hep B infection 12.4% (95%CIs: 9.5, 15.4), HIV 1% (95%CIs: 0.1, 1.9) and LTBI was 16.5% (95%CIs: 13.2, 19.8). 70.6% (95%CIs: 66.5, 74.6) had no or low immunity to Hep B. Almost one in three (29%) of those with current Hep C infection were co-infected with LTBI. All 51 individuals with current hep C were referred to health care services and at 12 months follow up one had completed treatment, one was on treatment, and 25 either did not attend or were lost to follow up. Conclusions: This is the first UK study which demonstrates the high prevalence of Hep C and co-infection with LTBI in homeless populations and a large unmet need for Hep C and LTBI treatment. Immunity to Hep B was extremely low in this high-risk group. Levels of engagement with standard NHS health services were extremely poor for those diagnosed with current Hep C, with just under half of those referred either did not attend appointments or were lost to follow up. Active case finding using integrated testing and case management strategies are urgently needed. FRI-401 OCCULT LIVER DISEASE BURDEN: ANALYSIS FROM A LARGE GENERAL PRACTITIONERS DATABASE A. Martini1, E. Ceranto1, A. Gatta1, P. Pontisso1. 1Department of Medicine, Internal Medicine and Hepatology, Regional Centre for Hepatology (RCH), University of Padua, Padua, Italy E-mail: [email protected] Background and Aims: Liver cirrhosis represents the end stage of chronic liver disease, characterized by high mortality and morbidity with relevant health and social costs. The real prevalence of this condition is difficult to assess, since liver disease is silent until clinical decompensation of cirrhosis occurs. The aim of this study was to estimate the prevalence of occult liver disease in the Veneto region and to compare the results with the burden of patient with overt diagnosis in the same geographic area. Methods: For the epidemiological analysis the MilleinRete dataset was used, where medical records of 139.104 subjects were stored by 99 general practitioners in the Veneto region. As indicators, transaminases elevation (>2 nv in at least two occasions) for occult chronic liver disease and thrombocytopenia (<120.000 μ/L) for occult liver cirrhosis, were used. Patients with thrombocytopenia due to hematologic disorders were excluded. Prevalence of patients with already diagnosed chronic hepatitis, cirrhosis and comorbidities was assessed using ICD9-CM-1997 codes. Results: Among 11.540 patients with elevated transaminases, 35% were already diagnosed as patients with liver disease of known etiology (viral hepatitis, alcohol abuse or hepatic steatosis), while in the remaining 65% no liver disease diagnosis was recorded. Sex distribution of these patients was similar to that of the patients without liver enzymes alteration (M/F:0.91 vs 0.9, respectively), while age was higher in patients with elevated transaminases [mean age (yrs) = 55.5 vs 48.9, p < 0.0001]. Patients with overt diagnosis of cirrhosis were 0.3% of the overall population, while thrombocytopenia, as indicator of occult cirrhosis, was detected in 1.3% of the remaining patients. The epidemiological profile of these two groups was similar [M/F:1.59; mean age (yrs) = 65.6 vs M/F:1.67; mean age (yrs) = 65 p = ns], but significantly different ( p < 0.0001) compared to the normal population and to subjects with only liver enzyme alterations. Patients with occult and overt cirrhosis presented a similar prevalence of metabolic syndrome profile (49%
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and 56% respectively), while these figures were lower in patients without signs of liver disease (33%, p < 0.0001). Conclusions: A large proportion of patients with chronic hepatitis and with cirrhosis are still undiagnosed. Metabolic syndrome seems to be the major risk factor that characterizes patients with more severe liver disease. FRI-402 KNOWLEDGE OF HEPATITIS C ACQUISITION RISKS IS ASSOCIATED WITH IMPROVED BIRTH COHORT-BASED SCREENING PRACTICES AMONG PRIMARY CARE PHYSICIANS S.T. Samuel1, A.D. Martinez1, S. Munjal1, E. George1, M. Basil1, Y. Chen2, R.B. Dimova1,2, A. Talal1. 1Medicine; 2Biostatistics, University at Buffalo, Buffalo, NY, United States E-mail: [email protected] Background and Aims: Overall, data from the United States suggest that 45–85 percent of patients infected with hepatitis C virus (HCV) are unaware of their infection status. The focus of HCV screening in primary care has shifted from that based upon risk factors to birth cohort-based screening of baby boomers (i.e. individuals born between 1945 and 1965). We aimed to assess primary care physician awareness, practice patterns, and knowledge related to the recent recommendations regarding birth cohort screening. Methods: An online questionnaire comprised of 45 questions was distributed to primary care physicians (PCPs) affiliated with University at Buffalo between June and December 2013. We evaluated PCP’s knowledge of HCV natural history, treatment, and ability to identify HCV risk factors. PCP knowledge was assessed by correctly answering a set of 18 questions (score> = 14, high knowledge). Our primary outcome was implementation of birth cohort-based screening recommendations. Associations between outcome variables and co-variates were accessed using logistic regression. Results: A total of 91 of 163 PCPs (56%) completed the survey. Most respondents (84%) were residents-in-training and 82% had recently ordered an HCV screening test. The most frequent reason to screen for HCV was abnormal liver enzymes (46%), assessment of HCV-related risk factors (29%), and being a member of the birth cohort (18%). Forty percent of PCPs were unaware of birth cohort screening recommendations. Despite identifying at least one risk factor for HCV, 30% of PCPs did not order an HCV screening test. Additionally, 45% of PCPs specified that they never or rarely document HCV screening in the medical record. Implementation of screening based upon birth cohort recommendations was associated with knowledge of HCV risk factors (OR = 5.18; 95%CI 1.8–16.1, p = 0.0032). PCPs who indicated that membership in the birth cohort was the single most important indication for HCV screening were more likely to apply the recommendations (OR = 9.54, 95%CI 2.6–47.1, p = 0.0018). Knowledge of HCV history and treatment did not predict PCP’s likelihood to screen baby boomers for HCV ( p = 0.4905). Conclusions: Clinical abnormalities continue to be the principal reason for PCPs to screen for HCV despite risk and birth cohort based screening recommendations. These findings underscore the need for educational interventions targeted to PCPs in order to improve implementation of current HCV screening guidelines. FRI-404 ACCEPTANCE, YIELD AND FEASIBILITY OF ATTACHING HCV BIRTH CONTROL SCREENING TO COLORECTAL CANCER SCREENING IN SPAIN D. Bonillo-Cambrodon1, F.-J. García-Alonso2, A. Algaba1, A. BermejoAbati1, J. García-Martínez3, P. Valer1, B. Piqueras-alcol1, F. Bermejo1 and Hospital Universitario de FUENLABRADA. 1Aparato Digestivo, Hospital Universitaro De Fuenlabrada; 2Aparato Digestivo, Hospital Universitario de Fuenlabrada; 3Hospital Universitaro De Fuenlabrada, Madrid, Spain E-mail: [email protected]
Journal of Hepatology 2016 vol. 64 | S425–S630
POSTER PRESENTATIONS Background and Aims: The US Centers for Disease Control recommends hepatitis C virus (HCV) screening for baby boomers born in the US. Spain presents a similar distribution of infected patients. We performed a prospective trial to evaluate the prevalence of undiagnosed HCV infection in subjects born between 1949 and 1975 and to assess the acceptability and yield of attaching HCV screening to colorectal cancer screening. Methods: All out-patients within the age range, both symptomatic and screening procedures, undergoing colonoscopy between December 2014 and June 2015 were offered a HCV antibody blood test and a survey including risk factors for HCV infection and attitude towards HCV screening. Patients with chronic HCV or with a previous negative HCV antibody test were excluded. Results: Among 934 subjects within the age range, a total of 570 subjects, 50% screening procedures, were analyzed. The median age was 55.7, 94.6% were born in Spain and 54.6% were women. Antibodies against HCV were found in 1.6% (0.8–3%) and HCV-RNA in 0.4% (0.1–1.3%). We found no statistically significant differences regarding HCV prevalence, risk factors or socioeconomic characteristics between subjects undergoing colorectal cancer screening and symptomatic subjects. HCV screening was supported by 77.7% (74.1–81.4%). Conclusions: Symptomatic and screening patients undergoing colonoscopy support HCV screening and present a similar HCV risk profile, suggesting linking colorectal cancer screening and HCV screening would yield good results. The prevalence of undiagnosed HCV warrants further evaluation of HCV birth cohort screening. FRI-405 ASSESSMENT OF RAPID TEST KITS TO DETECT HBSAG AND ANTI-HCV G. Jargalsaikhan1,2, O. Oidovsambuu1,3,4, B. Dashtseren1–3, D. Boldbaatar1,3, Z. Genden1,3, A. Tuya5, A. Bungert3, N. Dashdorj3, N. Gurjav2,6, N. Dashdorj1,3. 1Liver Center; 2Mongolian National University of Medical Science; 3Onom Foundation; 4National University of Mongolia; 5National Center of Transfusion Medicine; 6State Third Central Hospital, Mongolia, Ulaanbaatar, Mongolia E-mail: [email protected]
Background and Aims: Rapid test kits to detect HBsAg and anti-HCV are mostly used in resource-limited settings for initial screening especially in country like a Mongolia with high prevalences of HBV and HCV. Rapid test kits to detect HBsAg and anti-HCV could be ideal tools for HBV and HCV population screening for example as part of the Screening and Early Diagnosis Campaign of the Hepatitis Prevention, Control, and Elimination Program in Mongolia. The aim of this study was to assess the diagnostic accuracy of the rapid test kits for HBsAg and anti-HCV, which are most commonly used in the laboratory settings of Mongolia. Methods: The study design was cross-sectional. Total of 270 serum samples were assessed by 9 different rapid tests to detect anti-HCV (Ora Sure, Hexagon, Cypress, SD-Bioline, Genedia, Abon, Humasis, CTK, Wond-fo) and 8 different rapid tests to detect HBsAg (Hexagon, Cypress, SD-Bioline, Genedia, Abon, Humasis, CTK, Wond-fo). In addition, all samples were confirmed by ELISA and quantative PCR. Results: The analyses were performed on total of 270 serum samples, which were divided into 3 groups including the HCV-RNA positive group with 90 samples, the HBV-DNA positive group with 90 samples, and the all-negative donor group with 90 samples. The sensitivity and specificity of rapid tests to detect anti-HCV were as following: The sensitivity of OraQuick HCV (OraSure, USA), Hexagon (HUMAN, Germany), Cypress (Cypress Diagnostic, Belgium), SDBioline (Standart Diagnostics, Korea), Genedia (Green cross, Korea), Abon (Abon Biopharm, China), Humasis (Humasis, Korea), CTK (CTK Biotech, USA), and Wondfo (Wondfo Biotech, China) were 100%, 98.9%, 96.77%, 98.9%, 96.62%, 100%, 100%, 100%, 100%, while the specificity were 100%, 98.36%, 93.26%, 97.82%, 98.9%, 87.8%, 93.7%, 94.24% and 96.77%, respectively. The sensitivity of all rapid tests to detect HBsAg[AB2], Hexagon, Cypress, SD-Bioline, Genedia, Abon, Humasis, CTK, and Wond-fo were 100%, while the specificity of the tests were 97.29%, 95.74%, 100%, 100%, 100%, 100%, 98.36%, and 100%, respectively (Table 1). Conclusions: This study revealed, that OraQuick has high sensitivity and specificity for detecting anti-HCV, whereas tests from SD Bioline, Genedia, Abon, Humasis, and Wond-fo have high sensitivity and specificity to detect HBsAg. Despite lower specificity and sensitivity given economic constraints, a tradeoff between lower test costs and lower specificity can be advisable in some cases.
Table 1 (abstract: FRI-405): Characteristics and diagnostic accuracy of rapid test kits to detect HBsAg and anti-HCV No
Test kits
TP
FP
TN
FN
Sensitivity
Specificity
PPV
NPV
1
Hexagon (HUMAN, Germany)
HBsAg Anti-HCV
90 90
5 3
180 180
0 1
100% 98.90%
97,29% 98.36%
94.70% 96.77%
100% 99.44%
2
Cypress (Cypress Diagnostics, Belgium) SD-Bioline (Standart Diagnostics, Korea)
HBsAg Anti-HCV HBsAg Anti-HCV
90 90 90 90
8 12 0 4
180 180 180 180
0 3 0 3
100% 96.77% 100% 99%
95.74% 93.26% 100% 98%
91.83% 88.23% 100% 96%
100% 98.36% 100% 98%
4
Genedia (Green Cross, Genedia)
HBsAg Anti-HCV
90 90
0 2
180 180
0 3
100% 97%
100% 99%
100% 98%
100% 98%
5
Abon (Abon Biopharm, China)
6
Humasis (Humasis, Korea)
HBsAg Anti-HCV HBsAg Anti-HCV
90 90 90 90
0 25 0 11
180 180 180 180
0 0 0 0
100% 100% 100% 100%
100% 88% 100% 93,7%
100% 78% 100% 89%
100% 100% 100% 100%
7
CTK (CTK biotech Ink, USA)
HBsAg
90
3
180
0
100%
98.36%
96.77%
100%
Anti-HCV
90
12
180
0
100%
94.24%
88.23%
100%
HBsAg
90
0
180
0
100%
100%
100%
100%
Anti-HCV
90
6
180
0
100%
96.77%
93.75%
100%
anti-HCV
90
0
180
0
100%
100%
100%
100%
3
8
9
Wondfo (Wondfo Biotech, China)
OraQuick (Orasure, USA)
Journal of Hepatology 2016 vol. 64 | S425–S630
Sample serum, plasma serum, plasma, whole blood serum, plasma serum, plasma serum, plasma serum, plasma, whole blood serum, plasma serum, plasma, whole blood serum, plasma serum, plasma serum, plasma serum, plasma, whole blood serum, plasma, whole blood serum, plasma, whole blood serum, plasma, whole blood serum, plasma, whole blood serum, plasma, whole blood
Price per test 0.8 USD 1 USD 0.75 USD 0.9 USD 0.7 USD 0.78 USD 0.45 USD 0.6 USD 0.75 USD 0.9 USD 0.75 USD 0.9 USD 0.65 USD 0.75 USD 0.6 USD 0.8 USD 12 USD
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and 56% respectively), while these figures were lower in patients without signs of liver disease (33%, p < 0.0001). Conclusions: A large proportion of patients with chronic hepatitis and with cirrhosis are still undiagnosed. Metabolic syndrome seems to be the major risk factor that characterizes patients with more severe liver disease. FRI-402 KNOWLEDGE OF HEPATITIS C ACQUISITION RISKS IS ASSOCIATED WITH IMPROVED BIRTH COHORT-BASED SCREENING PRACTICES AMONG PRIMARY CARE PHYSICIANS S.T. Samuel1, A.D. Martinez1, S. Munjal1, E. George1, M. Basil1, Y. Chen2, R.B. Dimova1,2, A. Talal1. 1Medicine; 2Biostatistics, University at Buffalo, Buffalo, NY, United States E-mail: [email protected] Background and Aims: Overall, data from the United States suggest that 45–85 percent of patients infected with hepatitis C virus (HCV) are unaware of their infection status. The focus of HCV screening in primary care has shifted from that based upon risk factors to birth cohort-based screening of baby boomers (i.e. individuals born between 1945 and 1965). We aimed to assess primary care physician awareness, practice patterns, and knowledge related to the recent recommendations regarding birth cohort screening. Methods: An online questionnaire comprised of 45 questions was distributed to primary care physicians (PCPs) affiliated with University at Buffalo between June and December 2013. We evaluated PCP’s knowledge of HCV natural history, treatment, and ability to identify HCV risk factors. PCP knowledge was assessed by correctly answering a set of 18 questions (score> = 14, high knowledge). Our primary outcome was implementation of birth cohort-based screening recommendations. Associations between outcome variables and co-variates were accessed using logistic regression. Results: A total of 91 of 163 PCPs (56%) completed the survey. Most respondents (84%) were residents-in-training and 82% had recently ordered an HCV screening test. The most frequent reason to screen for HCV was abnormal liver enzymes (46%), assessment of HCV-related risk factors (29%), and being a member of the birth cohort (18%). Forty percent of PCPs were unaware of birth cohort screening recommendations. Despite identifying at least one risk factor for HCV, 30% of PCPs did not order an HCV screening test. Additionally, 45% of PCPs specified that they never or rarely document HCV screening in the medical record. Implementation of screening based upon birth cohort recommendations was associated with knowledge of HCV risk factors (OR = 5.18; 95%CI 1.8–16.1, p = 0.0032). PCPs who indicated that membership in the birth cohort was the single most important indication for HCV screening were more likely to apply the recommendations (OR = 9.54, 95%CI 2.6–47.1, p = 0.0018). Knowledge of HCV history and treatment did not predict PCP’s likelihood to screen baby boomers for HCV ( p = 0.4905). Conclusions: Clinical abnormalities continue to be the principal reason for PCPs to screen for HCV despite risk and birth cohort based screening recommendations. These findings underscore the need for educational interventions targeted to PCPs in order to improve implementation of current HCV screening guidelines. FRI-404 ACCEPTANCE, YIELD AND FEASIBILITY OF ATTACHING HCV BIRTH CONTROL SCREENING TO COLORECTAL CANCER SCREENING IN SPAIN D. Bonillo-Cambrodon1, F.-J. García-Alonso2, A. Algaba1, A. BermejoAbati1, J. García-Martínez3, P. Valer1, B. Piqueras-alcol1, F. Bermejo1 and Hospital Universitario de FUENLABRADA. 1Aparato Digestivo, Hospital Universitaro De Fuenlabrada; 2Aparato Digestivo, Hospital Universitario de Fuenlabrada; 3Hospital Universitaro De Fuenlabrada, Madrid, Spain E-mail: [email protected]
Journal of Hepatology 2016 vol. 64 | S425–S630
POSTER PRESENTATIONS Background and Aims: The US Centers for Disease Control recommends hepatitis C virus (HCV) screening for baby boomers born in the US. Spain presents a similar distribution of infected patients. We performed a prospective trial to evaluate the prevalence of undiagnosed HCV infection in subjects born between 1949 and 1975 and to assess the acceptability and yield of attaching HCV screening to colorectal cancer screening. Methods: All out-patients within the age range, both symptomatic and screening procedures, undergoing colonoscopy between December 2014 and June 2015 were offered a HCV antibody blood test and a survey including risk factors for HCV infection and attitude towards HCV screening. Patients with chronic HCV or with a previous negative HCV antibody test were excluded. Results: Among 934 subjects within the age range, a total of 570 subjects, 50% screening procedures, were analyzed. The median age was 55.7, 94.6% were born in Spain and 54.6% were women. Antibodies against HCV were found in 1.6% (0.8–3%) and HCV-RNA in 0.4% (0.1–1.3%). We found no statistically significant differences regarding HCV prevalence, risk factors or socioeconomic characteristics between subjects undergoing colorectal cancer screening and symptomatic subjects. HCV screening was supported by 77.7% (74.1–81.4%). Conclusions: Symptomatic and screening patients undergoing colonoscopy support HCV screening and present a similar HCV risk profile, suggesting linking colorectal cancer screening and HCV screening would yield good results. The prevalence of undiagnosed HCV warrants further evaluation of HCV birth cohort screening. FRI-405 ASSESSMENT OF RAPID TEST KITS TO DETECT HBSAG AND ANTI-HCV G. Jargalsaikhan1,2, O. Oidovsambuu1,3,4, B. Dashtseren1–3, D. Boldbaatar1,3, Z. Genden1,3, A. Tuya5, A. Bungert3, N. Dashdorj3, N. Gurjav2,6, N. Dashdorj1,3. 1Liver Center; 2Mongolian National University of Medical Science; 3Onom Foundation; 4National University of Mongolia; 5National Center of Transfusion Medicine; 6State Third Central Hospital, Mongolia, Ulaanbaatar, Mongolia E-mail: [email protected]
Background and Aims: Rapid test kits to detect HBsAg and anti-HCV are mostly used in resource-limited settings for initial screening especially in country like a Mongolia with high prevalences of HBV and HCV. Rapid test kits to detect HBsAg and anti-HCV could be ideal tools for HBV and HCV population screening for example as part of the Screening and Early Diagnosis Campaign of the Hepatitis Prevention, Control, and Elimination Program in Mongolia. The aim of this study was to assess the diagnostic accuracy of the rapid test kits for HBsAg and anti-HCV, which are most commonly used in the laboratory settings of Mongolia. Methods: The study design was cross-sectional. Total of 270 serum samples were assessed by 9 different rapid tests to detect anti-HCV (Ora Sure, Hexagon, Cypress, SD-Bioline, Genedia, Abon, Humasis, CTK, Wond-fo) and 8 different rapid tests to detect HBsAg (Hexagon, Cypress, SD-Bioline, Genedia, Abon, Humasis, CTK, Wond-fo). In addition, all samples were confirmed by ELISA and quantative PCR. Results: The analyses were performed on total of 270 serum samples, which were divided into 3 groups including the HCV-RNA positive group with 90 samples, the HBV-DNA positive group with 90 samples, and the all-negative donor group with 90 samples. The sensitivity and specificity of rapid tests to detect anti-HCV were as following: The sensitivity of OraQuick HCV (OraSure, USA), Hexagon (HUMAN, Germany), Cypress (Cypress Diagnostic, Belgium), SDBioline (Standart Diagnostics, Korea), Genedia (Green cross, Korea), Abon (Abon Biopharm, China), Humasis (Humasis, Korea), CTK (CTK Biotech, USA), and Wondfo (Wondfo Biotech, China) were 100%, 98.9%, 96.77%, 98.9%, 96.62%, 100%, 100%, 100%, 100%, while the specificity were 100%, 98.36%, 93.26%, 97.82%, 98.9%, 87.8%, 93.7%, 94.24% and 96.77%, respectively. The sensitivity of all rapid tests to detect HBsAg[AB2], Hexagon, Cypress, SD-Bioline, Genedia, Abon, Humasis, CTK, and Wond-fo were 100%, while the specificity of the tests were 97.29%, 95.74%, 100%, 100%, 100%, 100%, 98.36%, and 100%, respectively (Table 1). Conclusions: This study revealed, that OraQuick has high sensitivity and specificity for detecting anti-HCV, whereas tests from SD Bioline, Genedia, Abon, Humasis, and Wond-fo have high sensitivity and specificity to detect HBsAg. Despite lower specificity and sensitivity given economic constraints, a tradeoff between lower test costs and lower specificity can be advisable in some cases.
Table 1 (abstract: FRI-405): Characteristics and diagnostic accuracy of rapid test kits to detect HBsAg and anti-HCV No
Test kits
TP
FP
TN
FN
Sensitivity
Specificity
PPV
NPV
1
Hexagon (HUMAN, Germany)
HBsAg Anti-HCV
90 90
5 3
180 180
0 1
100% 98.90%
97,29% 98.36%
94.70% 96.77%
100% 99.44%
2
Cypress (Cypress Diagnostics, Belgium) SD-Bioline (Standart Diagnostics, Korea)
HBsAg Anti-HCV HBsAg Anti-HCV
90 90 90 90
8 12 0 4
180 180 180 180
0 3 0 3
100% 96.77% 100% 99%
95.74% 93.26% 100% 98%
91.83% 88.23% 100% 96%
100% 98.36% 100% 98%
4
Genedia (Green Cross, Genedia)
HBsAg Anti-HCV
90 90
0 2
180 180
0 3
100% 97%
100% 99%
100% 98%
100% 98%
5
Abon (Abon Biopharm, China)
6
Humasis (Humasis, Korea)
HBsAg Anti-HCV HBsAg Anti-HCV
90 90 90 90
0 25 0 11
180 180 180 180
0 0 0 0
100% 100% 100% 100%
100% 88% 100% 93,7%
100% 78% 100% 89%
100% 100% 100% 100%
7
CTK (CTK biotech Ink, USA)
HBsAg
90
3
180
0
100%
98.36%
96.77%
100%
Anti-HCV
90
12
180
0
100%
94.24%
88.23%
100%
HBsAg
90
0
180
0
100%
100%
100%
100%
Anti-HCV
90
6
180
0
100%
96.77%
93.75%
100%
anti-HCV
90
0
180
0
100%
100%
100%
100%
3
8
9
Wondfo (Wondfo Biotech, China)
OraQuick (Orasure, USA)
Journal of Hepatology 2016 vol. 64 | S425–S630
Sample serum, plasma serum, plasma, whole blood serum, plasma serum, plasma serum, plasma serum, plasma, whole blood serum, plasma serum, plasma, whole blood serum, plasma serum, plasma serum, plasma serum, plasma, whole blood serum, plasma, whole blood serum, plasma, whole blood serum, plasma, whole blood serum, plasma, whole blood serum, plasma, whole blood
Price per test 0.8 USD 1 USD 0.75 USD 0.9 USD 0.7 USD 0.78 USD 0.45 USD 0.6 USD 0.75 USD 0.9 USD 0.75 USD 0.9 USD 0.65 USD 0.75 USD 0.6 USD 0.8 USD 12 USD
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