Hepatitis B virus screening before chemotherapy for lymphoma: a cost-effectiveness analysis.
OBJECTIVE
Hepatitis B virus (HBV) reactivation is a potentially fatal complication of chemotherapy that can be largely prevented with antiviral prophylaxis. It remains unclear whether HBV screening is cost effective.


METHODS
A decision model was developed to compare the clinical outcomes, costs, and cost effectiveness of three HBV screening strategies for patients with lymphoma before R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy: screen all patients for hepatitis B surface antigen (HBsAg; Screen-All), screen patients identified as being at high risk for HBV infection (Screen-HR), and screen no one (Screen-None). Patients testing positive were administered antiviral therapy until 6 months after completion of chemotherapy. Those not screened were initiated on antiviral therapy only if HBV hepatitis occurred. Probabilities of HBV and lymphoma outcomes were derived from systematic literature review. A third-party payer perspective was adopted, costs were expressed in 2011 Canadian dollars, and a 1-year time horizon was used.


RESULTS
Screen-All was the dominant strategy. It was least costly at $32,589, compared with $32,598 for Screen-HR and $32,657 for Screen-None. It was also associated with the highest 1-year survival rate at 84.99%, compared with 84.96% for Screen-HR and 84.86% for Screen-None. The analysis was sensitive to the prevalence of HBsAg positivity in the low-risk population, with Screen-HR becoming least costly when this value was ≤ 0.20%.


CONCLUSIONS
In patients receiving R-CHOP for lymphoma, screening all patients for HBV reduces the rate of HBV reactivation (10-fold) and is less costly than screening only high-risk patients or screening no patients.
University of Toronto, Toronto, ON, Canada.
Urszula
U
Zurawska
Lisa K
LK
Hicks
Gloria
G
Woo
Chaim M
CM
Bell
Murray
M
Krahn
Kelvin K
KK
Chan
Jordan J
JJ
Feld
D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D003362:Cost-Benefit Analysis; D003520:Cyclophosphamide / Q000009:adverse effects; D003661:Decision Support Techniques; D004317:Doxorubicin / Q000009:adverse effects; D042241:Early Diagnosis; D006509:Hepatitis B / Q000175:diagnosis* / Q000191:economics*; D006514:Hepatitis B Surface Antigens / Q000032:analysis; D006515:Hepatitis B virus; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy / Q000191:economics* / Q000821:virology*; D008875:Middle Aged; D011241:Prednisone / Q000009:adverse effects; D000069283:Rituximab; D016896:Treatment Outcome; D014750:Vincristine / Q000009:adverse effects; D014775:Virus Activation / Q000187:drug effects
D058846:Antibodies, Monoclonal, Murine-Derived; D006514:Hepatitis B Surface Antigens; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone