Computerized Physician Order Entry-Based System Improves Hepatitis B Virus Screening in Patients Undergoing Chemotherapy.

Abstract

TO THE EDITOR: In the clinical opinion update by Hwang et al, the authors reviewed the most important issues related to hepatitis B virus (HBV) screening in patients who are about to receive cytotoxic chemotherapy for the treatment of malignant diseases. This update notes the importance of screening all patients who are going to be treated with anti-CD20 therapy. The authors also point out that this screening should be extended to patients with high risk factors for HBV infection. Then, when a patient who is hepatitis B surface antigen (HBsAg) positive/hepatitis B core antibody (anti-HBc) positive is identified, antiviral treatment should be started just before or at the same time as chemotherapy. In contrast, patients who are HBsAg negative/anti-HBc positive could be carefully observed with ALT and HBV-DNA levels. In the article by Hwang et al, Spain is included as a country with HBV prevalence greater than 2%. We believe this statement is currently obsolete and should be corrected. Because of the universal vaccination program started circa 1992, the HBV prevalence in Spain is now approximately 0.7% (HBsAg positive). However, this 0.7% prevalence in HBsAg does not disqualify, in our opinion, a universal HBsAg screening for all patients scheduled to receive systemic cancer therapy. As Hwang et al succinctly mentioned, previous studies have shown that universal screening for HBsAg is not only cost effective but actually cost saving when compared with no screening or screening only high-risk individuals before starting chemotherapy, particularly when the prevalence of HBsAg in the low-risk population is greater than 0.20%. Finally, one aspect that we miss in this special article is the mention of currently available innovative strategies to facilitate this HBV screening in the hospital setting, where the majority of immunosuppressive therapies are prescribed. We are referring specifically to the use of the computerized physician order entry–based (CPOE) systems that apply to this subject. As we previously have demonstrated, the use of this CPOE system in our hospital increased theHBV screening rate from less than 50% to 94% forHBsAg and from less than 30% to 85% for anti-HBc in patients for whom a biologic drug was prescribed. In conclusion, we consider it reasonable to recommend universal HBsAg (and anti-HBc) screening for all patients scheduled to receive systemic cancer therapies or other immunosuppressive therapies, adding when available or feasible the potential benefits of new tools such as CPOE systems together with educational efforts to improve the HBV screening rates.