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Folate Testing: A Review of the Diagnostic Accuracy, Clinical Utility, Cost-Effectiveness and Guidelines

Last updated: July 23, 2015
Project Number: RC0680-000
Product Line: Rapid Response
Research Type: Other Diagnostics
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the diagnostic accuracy of red blood cell folate versus serum folate testing for identifying folate deficiency?
  2. What is the comparative clinical utility of red blood cell folate versus serum folate testing?
  3. What is the clinical utility of folate testing?
  4. What is the cost-effectiveness of folate testing?
  5. What are the evidence-based guidelines regarding appropriate indications for folate testing?
  6. What are the evidence-based guidelines regarding which assay to use for folate testing?

Key Message

There is insufficient evidence to support the clinical utility of folate testing in patients at risk of folate deficiency, particularly in folic acid fortified regions. Evidence-based guidelines provide recommendations based primarily on low quality evidence and expert consensus to support the use of folate testing in specific clinical populations. There was general agreement among several guidelines that serum folate is preferable to RBC folate; however, no evidence was identified the diagnostic accuracy or comparative clinical utility of the respective assays. The resource implications of folate testing are unclear.