Approximate Cost of HLA-B27 Test
The approximate cost of an HLA-B27 test is about €40 (approximately $45-50 USD), which is equivalent to the cost of a standard chest or pelvis X-ray examination. 1
Cost Comparison with Other Laboratory Tests
- HLA-B27 testing is more expensive than basic inflammatory markers like C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR), which cost approximately €15 each 1
- The cost is comparable to or slightly higher than antibody testing for infectious diseases, such as the IgG plus IgM ELISA test for Borrelia burgdorferi (Lyme disease), which costs about €35 1
Cost-Effectiveness Considerations
- HLA-B27 testing is generally considered cost-effective because it only needs to be performed once in a patient's lifetime, as genetic markers do not change 1
- In screening for axial spondyloarthritis (axSpA) among patients with chronic low back pain, HLA-B27 testing has been found to be cost-effective despite its higher initial cost compared to clinical assessment alone 1
- The test has high sensitivity (90%) and specificity (90%) for axial spondyloarthritis, making it an efficient screening tool where only three HLA-B27 positive patients need to be evaluated by a rheumatologist to diagnose one case of axial SpA 1
Testing Methods and Associated Costs
- Flow cytometry using monoclonal antibodies is considered a cost-effective method for HLA-B27 typing due to its speed, simplicity, and economy 2
- Next-generation sequencing (NGS) technologies have significantly reduced the cost of HLA typing in general, with some studies reporting cost reductions of up to 95% compared to traditional Sanger-based typing methods 3
Clinical Value Relative to Cost
- HLA-B27 testing is particularly valuable in evaluating patients with chronic low back pain with onset before age 45, as 60-90% of axial spondyloarthritis patients worldwide carry this genetic marker 4
- The test is frequently ordered by both rheumatologists (39.7%) and ophthalmologists (21.4%), with the highest positive rates seen in patients with reactive arthritis (50%) and uveitis 5
Important Considerations
- Despite its clinical utility, HLA-B27 testing should be used judiciously, as approximately half of HLA-B27 positive patients may not be referred to rheumatology for appropriate follow-up 5
- The risk of developing ankylosing spondylitis is 16 times greater in HLA-B27 positive relatives of patients with ankylosing spondylitis compared to HLA-B27 positive individuals in the general population 6