Hepatitis B prophylaxis in patients undergoing chemotherapy for lymphoma: a decision analysis model.
Hepatitis B reactivation is a major cause of morbidity and mortality in patients undergoing chemotherapy for lymphomas. These patients may experience direct liver-related complications or reduced cancer survival because of interruptions in chemotherapy. Our aim was to compare the costs and outcomes of 2 different chronic hepatitis B management strategies. In hepatitis B carriers undergoing chemotherapy, we pursued a decision analysis model to compare the costs and clinical outcomes of using lamivudine prophylaxis versus initiating lamivudine only when clinically overt hepatitis occurred. Our results indicate that the use of lamivudine prophylaxis is cost-effective. Even though the use of lamivudine prophylaxis was associated with an incremental cost of $1530 per patient ($18,707 versus $17,177), both the number and severity of hepatitis B reactivations were reduced. None of the patients in the prophylaxis group had liver-related deaths versus 20 who died in the no-prophylaxis group. Cancer deaths were also reduced from 47-39 with lamivudine prophylaxis, presumably because of the increased need for cessation or modification of chemotherapy in patients who had severe hepatitis B virus flares. The incremental cost-effectiveness ratio of using lamivudine prophylaxis was $33,514 per life year saved.


CONCLUSIONS
Our results provide pharmacoeconomic support for the use of lamivudine prophylaxis in patients undergoing chemotherapy for lymphoma treatment.
Department of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA. ssaab@mednet.ucla.edu
Sammy
S
Saab
Mamie H
MH
Dong
Tom A
TA
Joseph
Myron J
MJ
Tong
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000191:economics; D003661:Decision Support Techniques; D004317:Doxorubicin / Q000008:administration & dosage / Q000191:economics; D017048:Health Care Costs / Q000706:statistics & numerical data; D006509:Hepatitis B / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D019259:Lamivudine / Q000191:economics / Q000627:therapeutic use; D008113:Liver Neoplasms / Q000150:complications / Q000188:drug therapy*; D008223:Lymphoma / Q000150:complications / Q000188:drug therapy*; D011239:Prednisolone / Q000008:administration & dosage / Q000191:economics; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage / Q000191:economics
D000998:Antiviral Agents; D019259:Lamivudine; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone