{
  "abstract": "The 2017 guideline-recommended gating strategy (RGS) for antineutrophil cytoplasmic antibody (ANCA) testing for ANCA-associated vasculitis (AAV) diagnosis has not been evaluated in Australia, and the optimal gating strategy remains unclear. We aimed to determine the performance characteristics of the RGS, a novel classification criteria-based gating strategy (CCGS) and the non-gated strategy (NGS) and estimated local cost-savings. We performed a retrospective analysis of ANCA tests at a tertiary referral laboratory (n=516, 19 AAV cases). NGS had 89.5% sensitivity, 98.2% specificity, 65.4% positive predictive value (PPV), 99.6% negative predictive value (NPV), likelihood ratios (LR+ and LR−) LR+49.4 and LR– 0.11. RGS had improved PPV (94.4%) and LR+ (444.7) and would have avoided 79.8% of ANCA tests. CCGS performed the same but would have avoided 85.9% of ANCA tests. No AAV cases were missed. CCGS would have yielded annual healthcare cost-savings of $A86 574. Implementing gating strategies may improve ANCA diagnostic performance for AAV, reduce testing volume and lead to significant healthcare cost-savings.",
  "authors": [
    {
      "affiliations": [
        "Department of Clinical Immunology and Allergy, Royal North Shore Hospital, St Leonards, New South Wales, Australia",
        "Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, St Leonards, New South Wales, Australia"
      ],
      "name": "Yi Tong Vincent Aw"
    },
    {
      "affiliations": [
        "Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, St Leonards, New South Wales, Australia",
        "Immunology Laboratory, Royal North Shore Hospital, Sydney, New South Wales, Australia"
      ],
      "name": "Jason Chun Lao"
    },
    {
      "affiliations": [
        "Immunology Laboratory, Royal North Shore Hospital, Sydney, New South Wales, Australia"
      ],
      "name": "Richard Fulton"
    },
    {
      "affiliations": [
        "Department of Clinical Immunology and Allergy, Royal North Shore Hospital, St Leonards, New South Wales, Australia",
        "Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, St Leonards, New South Wales, Australia"
      ],
      "name": "Jamma Li"
    },
    {
      "affiliations": [
        "Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, St Leonards, New South Wales, Australia",
        "Immunology Laboratory, Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, New South Wales, Australia"
      ],
      "name": "Suran L Fernando"
    }
  ],
  "title": "A classification criteria-based gating strategy improves anti-neutrophil cytoplasmic antibody (ANCA) testing performance characteristics for the diagnosis of ANCA-associated vasculitis",
  "uid": "55e1c6bd-7686-56f3-b128-b245c1eff786"
}