HBV Screening Recommended with Chemotherapy, but Not Cost-Effective in Solid Tumors
Most professional guidelines now recommend screening for hepatitis B virus (HBV) infection in essentially all patients receiving chemotherapy, but it is seldom performed and is not cost-effective in patients with solid (nonhematologic) tumors, according to studies presented at ASCO 2011.
Researchers at the University of Texas M.D. Anderson Cancer Center, Houston, used their database to evaluate the prevalence of HBV infection before chemotherapy and of reactivation of the virus during treatment by comparing patient and treatment characteristics in those with and without HBV reactivation.
Of the 10,729 patients who received chemotherapy, 1787 (17%) patients were screened and 151 (8%) tested positive for HBV surface antigen and/or anti-HBc (core antibody).
Reactivation occurred in 73 of these patients and was most common amongAsians and patientswith hematologic cancer.
“Overall, we found low rates of HBV screening prior to chemotherapy, and we found that preventable reactivation of HBV infection is common,” Jessica Hwang, MD, MPH, said.
A study from Australian investigators suggests universal screening is not cost-effective, at least in patients with solid tumors.
According to Fiona L. Day, MD, of Peter MacCallum Cancer Center, Melbourne, approximately 50% of Australian oncologists screen for HBV; only 19% screen every patient.
A decision-analytic model was used to compare universal screening versus no screening in hypothetical patient cohorts, one consisting of patients receiving adjuvant chemotherapy for early breast cancer (adjuvant cohort), one of patients receiving palliative chemotherapy for advanced non– small-cell lung cancer (palliative cohort), and one in which results from all patients were pooled.
Using an incremental cost-effectiveness ratio (ICER) threshold of $50,000 Australian per life-year (LY) saved, universal HBV screening was not costeffective for patients who received adjuvant chemotherapy (ICER of $88,173/LY, 13% probability of being cost-effective), patients who received palliative chemotherapy (ICER >$1.3 million/LY, 0% probability of being cost-effective), or all pooled patients with solid tumors (ICER of $149,771/ LY, 1% probably of cost-effectiveness).
A sensitivity analysis showed that screening approached cost-effectiveness among patients receiving adjuvant chemotherapy who had the highest rate (65%) of undiagnosed chronic HBV infection, for whom the ICER was $51,979/LY, or the highest chance of reactivation with chemotherapy (41%), for whom the ICER was $48,779/LY.