M1911 Cost-Effectiveness of Screening for Hepatitis B Infection Among Asian-Americans Undergoing Chemotherapy

Abstract

BACKGROUND: Although the cost-effectiveness of prophylactic lamivudine for patients with known hepatitis B virus (HBV) infection undergoing lymphoma treatment is well established, the cost effectiveness of screening persons with unknown HBV status prior to starting chemotherapy is unknown. Recent studies have shown that most cancer centers do not routinely perform such screening. We hypothesized that screening all high-risk patients for HBV prior to starting chemotherapy would be cost-effective. METHODS: For our base case, we considered a hypothetical cohort of 60 year old Asian-American males with Stage IIIV non-Hodgkin's lymphoma in whom chemotherapy with cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP) was planned. We used a decision analysis model to compare three competing strategies prior to initiation of chemotherapy: (1) no HBV prophylaxis, (2) prophylaxis with lamivudine only among patients with previously known HBV infection, and (3) screening all patients for HBV infection and giving prophylaxis to those found to be infected. We examined the cost effectiveness of each strategy over a time horizon of 1 year with no discounting. Sensitivity analysis was carried out on all variables, most notably prevalence of HBV infection and risk of reactivation. RESULTS: The universal screening strategy was associated with both a lower cost and higher effectiveness than the other two strategies. It remained the dominant strategy even if the prevalence of HBV infection fell to 1% (base case = 9%) or the risk of reactivation fell to 22% (base case = 43%). It also remained the preferred strategy over a wide range of costs for anti-viral medication, suggesting that newer agents such as entecavir and adefovir would be also be appropriate in this setting. CONCLUSION: Screening all Asian American patients for HBV infection prior to initiation of cytotoxic chemotherapy for lymphoma is highly cost-effective. The fact that it remains a preferred strategy even with a 1% prevalence of HBV infection suggests that screening might be advisable in lower-risk populations as well. Probabilities and Costs Used in Model