‘Screen all approach’ for HBV prior to chemotherapy most cost-effective

Screening all patients with solid tumors for hepatitis B before they underwent chemotherapy was the most cost-effective strategy, compared with not screening or only screening high-risk patients, according to a published study.

The rates of prior HBV exposure among patients with newly diagnosed cancer ranged from 5.6% to 7.4% and many individuals are unaware of their infection, putting them at a high-risk for HBV reactivation during immunosuppressive therapy or cancer chemotherapy, according to Gauree G. Konijeti, MD, from the Scripps Clinic in California, and colleagues.

“Determination of a cost-effective strategy for screening in this population is an important research need and clinical priority,” they wrote.

In their primary model using 2018 cost estimates, Konijeti and colleagues found that screening all patients was the most cost-effective at a willingness to pay (WTP) threshold of $50,000 per quality-adjusted life years, with an incremental cost-effectiveness ratio of $41,078 compared with only screening high-risk patients.

Screening no patients was less effective and less costly than either screening everyone or only high-risk patients.

Further analysis indicated that screening all patients was more likely to be cost-effective than only screening high-risk patients with a WTP threshold higher than $40,274.

When the researchers compared the incremental cost-effectiveness at a WTP threshold of $50,000 per quality-adjusted life years, the screen all approach was preferred in 54% of trials compared with the high-risk only approach and in 63% of trials compared with screening no patients.

“Based on our results, guidelines should be reexamined and consider recommending HBV testing prior to all solid tumor chemotherapy,” Konijeti and colleagues concluded. – by Talitha Bennett

Disclosures: Konijeti reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.