{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T03:07:39Z","timestamp":1778900859287,"version":"3.51.4"},"reference-count":15,"publisher":"American Society for Microbiology","issue":"12","license":[{"start":{"date-parts":[[2013,12,1]],"date-time":"2013-12-01T00:00:00Z","timestamp":1385856000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["J Clin Microbiol"],"published-print":{"date-parts":[[2013,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:p>The mainstay of laboratory diagnosis for Lyme disease is two-tiered serological testing, in which a reactive first-tier enzyme-linked immunosorbent assay (ELISA) or an immunofluorescence assay is supplemented by separate IgM and IgG immunoblots. Recent data suggest that the C6 ELISA can be substituted for immunoblots without a reduction in either sensitivity or specificity. In this study, the costs of 4 different two-tiered testing strategies for Lyme disease were compared using the median charges for these tests at 6 commercial diagnostic laboratories in 2012. The study found that a whole-cell sonicate ELISA followed by the C6 ELISA was the most cost-effective two-tiered testing strategy for Lyme disease with acute-phase serum samples. We conclude that the C6 ELISA can substitute for immunoblots in the two-tiered testing protocol for Lyme disease without a loss of sensitivity or specificity and is less expensive.<\/jats:p>","DOI":"10.1128\/jcm.01853-13","type":"journal-article","created":{"date-parts":[[2013,9,26]],"date-time":"2013-09-26T03:27:29Z","timestamp":1380166049000},"page":"4045-4049","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":54,"title":["Comparative Cost-Effectiveness of Two-Tiered Testing Strategies for Serodiagnosis of Lyme Disease with Noncutaneous Manifestations"],"prefix":"10.1128","volume":"51","author":[{"given":"Gary P.","family":"Wormser","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, New York Medical College, Valhalla, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Levin","sequence":"additional","affiliation":[{"name":"Immunetics, Inc., Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandeep","family":"Soman","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, New York Medical College, Valhalla, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Omosalewa","family":"Adenikinju","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, New York Medical College, Valhalla, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael V.","family":"Longo","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, New York Medical College, Valhalla, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John A.","family":"Branda","sequence":"additional","affiliation":[{"name":"Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","first-page":"1","article-title":"Summary of notifiable diseases: United States, 2011","volume":"60","author":"Adams DA","year":"2013","unstructured":"AdamsDAGallagherKMJajoskyRAKrisemanJSharpPAndersonWJAranasAEMayesMWodajoMSOnwehDHAbelleraJP. 2013. 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