ArticleScientific reports2025
Double reflex testing improves the efficacy and cost effectiveness of hepatitis delta diagnosis in southern Spain.
Article in Scientific reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Review
- From Diagnosis to Durability: A Review of the European Bulevirtide Experience and Practical Learnings for CHD Management.Liver international : official journal of the International Association for the Study of the Liver · 2026Review
- Improvement in the Microbiological Diagnosis of Hepatitis D on the Mediterranean Coast of Southeastern Spain: A Repeated Cross-Sectional Survey.Health science reports · 2026Article
- Nationwide Implementation of Double Reflex Testing for Hepatitis Delta in Spain: Results From the Retrospective Phase of the Spain-DDR Study.Alimentary pharmacology & therapeutics · 2026Article
- Hepatitis D Virus: Enigmas and Gaps of Knowledge.Viruses · 2026Review
- Double reflex testing for anti-HDV antibody following an HBsAg-positive test result and HDV RNA in those anti-HDV positive: a global systematic review and meta-analysis.EClinicalMedicine · 2026Article
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Authors and funding
39 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
This study aims to evaluate the prevalence of undiagnosed hepatitis delta in southern Spain (Andalusia) and assess the effectiveness and cost-efficiency of implementing reflex testing for hepatitis D detection in HBsAg-positive patients. A multicenter ambispective study was conducted in 17 Andalusian hospitals. The retrospective phase (January 2018-June 2022) analyzed diagnostic processes for hepatitis delta in HBsAg-positive patients. The prospective phase (October 2022-March 2023) implemented reflex testing, performing anti-HDV serology on all HBsAg-positive patients without prior testing. HDV RNA testing followed for those who tested anti-HDV-positive. In the retrospective phase, out of 18,583 HBsAg-positive patients, anti-HDV tests were performed on 3,436 (18%), identifying 205 (6%) positive cases. HDV RNA was tested in 158 (77%) anti-HDV-positive patients, with 69 (44%) testing positive. In the prospective phase, out of 2,384 HBsAg-positive patients without prior anti-HDV testing, 2,293 (96%) were tested, identifying 109 (4.7%) positive cases. HDV RNA was analyzed in 97 (89%) anti-HDV-positive patients, with 30 (31%) testing positive. Reflex testing increased anti-HDV detection by 77%, resulting in a fourfold increase in detecting anti-HDV-positive patients and a threefold increase in detecting HDV RNA-positive patients, reducing undiagnosed HDV RNA-positive cases to 4% compared to 45% with clinical practice. Cost analysis indicated a saving of €265,954 with reflex testing. Reflex testing improves HDV detection, reduces costs, and simplifies diagnosis, making it an efficient strategy for managing chronic hepatitis D patients.
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