Korean J Lab Med.  2008 Apr;28(2):160-168. 10.3343/kjlm.2008.28.2.160.

Meta-Analysis for the Pooled Sensitivity and Specificity of Hepatitis B Surface Antigen Rapid Tests

• Hwang SH
• Oh HB
• Choi SE
• Kim HH
• Chang CL
• Lee EY
• Son HC

• KMID: 854857
• DOI: http://doi.org/10.3343/kjlm.2008.28.2.160

Abstract

BACKGROUND: Although hepatitis B surface antigen (HBsAg) rapid test based on immunochromatographic assay (ICA) is now widely used, the test has not been evaluated sufficiently enough to validate its performance. Thus, it is important to summarize the clinical performance of the test kits. In this study, we performed meta-analysis for the performance of the HBsAg rapid tests. METHODS: PubMed database was searched using keywords about the accuracy of diagnostic tests for hepatitis B virus (HBV) infection. Two investigators assessed methodological quality utilizing standards for reporting of diagnostic accuracy studies (STARD) checklist. After performing a heterogeneity test, we obtained pooled sensitivity and specificity. Positive and negative predictive values (PPV and NPV) were simulated according to HBV prevalence. RESULTS: A total of 38 studies was selected from 10 papers. The quality scores ranged from 3 to 13 (median, 8). Kappa value was good (0.85). The performance of the 38 studies was heterogeneous. When 33 studies with better quality from 7 papers were re-selected, the pooled sensitivity and specificity were 98.07% (95% confidence interval, CI: 97.67-98.47%) and 99.56% (95% CI: 99.21-99.91%), respectively. With an HBV prevalence of 5%, PPV and NPV were predicted to be 92.14% and 99.90%, respectively. CONCLUSIONS: In view of high HBV prevalence in Korea, it is thought that the HBsAg rapid test can be used for HBV screening in small-sized laboratories or for epidemiologic studies. This study should be helpful in establishing a guideline for the proper performance evaluation of the HBsAg rapid tests.

Keyword

HBsAg; Rapid test; Performance evaluation; Meta-analysis

MeSH Terms

Chromatography/methods
Hepatitis B/*diagnosis
Hepatitis B Surface Antigens/*blood
Humans
Sensitivity and Specificity
Time Factors

Figure

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  Fig. 1. Funnel plots for publication bias of sensitivities (A), and specificities (B).

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  Fig. 2. Estimates of sensitivity and specificity of HBsAg rapid tests. Points indicate estimates of sensitivities (A) and specificities (B). Vertical lines are 95% confidence intervals for estimates.

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  Fig. 3. Predictive values according to prevalence with pooled sensitivity (98.07%) and specificity (99.56%). The Y axis plot positive predictive value (PPV) (A), and negative predictive value (NPV) (B).

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