COST-EFFECTIVENESS ANALYSIS OF ROUTINE SCREENING FOR HEPATITIS B PRIOR TO CHEMOTHERAPY FOR NON-HODGKIN'S LYMPHOMA

Purpose: To determine the cost-effectiveness of routinely screening all patients for HBV prior to starting chemotherapy in the United States.

 Methods:  A decision analysis model was made to compare 3 HBV screening strategies in a hypothetical cohort of 60 year old patients with newly-diagnosed Stage II-IV non-Hodgkin’s lymphoma for whom chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is planned.  Base-case and sensitivity parameters were extracted from a review of the literature.  Strategy 1 involves no routine HBV screening and prophylaxis.  Strategy 2 involves no routine HBV screening, but prophylaxis for those known to have chronic HBV.  Strategy 3 involves routine HBV screening with a serology test, hepatitis B surface antigen (HBsAg) and prophylaxis when identified.  All analysis was performed on TreeAge Pro 2008 (Williamstown, MA).

 Results:  No routine HBV screening, but anti-viral prophylaxis for those known to have chronic HBV (Strategy 2) is preferred based on base-case assumptions.  Strategy 1 was dominated by strategy 2.  The incremental cost-effectiveness ratio between Strategy 2 to Strategy 3 is $270,988 per life-year gained.  In a sensitivity analysis, a prevalence of chronic HBV that exceeds 0.8% makes routine HBV screening (Strategy 3) cost-effective.  When it exceeds 1.1%, routine screening becomes cost-saving.

 Conclusion:  Routine screening is not cost-effective in a low prevalence region such as the United States based on conventional standards.  However, it becomes cost-effective for any sub-population within the US whose prevalence of chronic HBV exceeds 0.8%.