title: Cost-effectiveness of universal hepatitis B virus screening in patients beginning chemotherapy for solid tumors.
abstract: OBJECTIVE
  Universal screening for chronic hepatitis B virus (HBV) infection before chemotherapy has been recommended. We evaluated the cost-effectiveness of HBV screening before chemotherapy given for nonhematopoietic solid tumors (STs).
  
  
  METHODS
  A decision-analytic model was used to compare the cost-effectiveness of universal screening conducted per professional guidelines versus no screening in hypothetical patient cohorts beginning adjuvant chemotherapy for early breast cancer or palliative chemotherapy for advanced non-small-cell lung cancer. Survival times were extrapolated using Markov models. Probabilities were derived from published studies and costs estimated from the perspective of the Australian health care system. One-way and probabilistic sensitivity analyses were performed, including with the application of an alternative HBV screening strategy.
  
  
  RESULTS
  Using an incremental cost-effectiveness ratio threshold of $50,000 (Australian dollars) per life-year (LY) saved, universal HBV screening was not cost-effective for adjuvant patients ($88,224/LY, 13% probability of being cost-effective), palliative patients ($1,344,251/LY, 0%), or pooled (all) patients ($149,857/LY, 1%). Sensitivity analyses found that screening approached cost-effectiveness among adjuvant patients with the highest reported rates of undiagnosed chronic HBV (65%, $59,445/LY) or HBV reactivation with chemotherapy (41%, $56,537/LY). Cost- effectiveness was also significantly influenced by HBV population prevalence. An alternative screening strategy using hepatitis B surface antigen testing only produced the most economically favorable results, with $30,126/LY (80% probability) for adjuvant patients and $51,201/LY (43%) for the pooled cohort.
  
  
  CONCLUSIONS
  Universal HBV screening conducted per current guidelines is not cost-effective in patients with STs. Screening may be economically favorable in selected patient subpopulations and/or with simplification of the screening strategy.
authors.affiliation: Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
authors.forename: Fiona L
authors.initials: FL
authors.lastname: Day
authors.forename: Jonathan
authors.initials: J
authors.lastname: Karnon
authors.forename: Danny
authors.initials: D
authors.lastname: Rischin
mesh_terms: D000328:Adult; D001315:Australia; D017024:Chemotherapy, Adjuvant; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D019694:Hepatitis B, Chronic / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D006801:Humans; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D009369:Neoplasms / Q000188:drug therapy* / Q000821:virology*