Cost-effectiveness of preventing hepatitis B virus reactivation in patients with lymphoma and resolved HBV infection
Journal
Journal of the Formosan Medical Association
Journal Volume
119
Journal Issue
1P2
Pages
335-344
Date Issued
2020
Author(s)
Tsou H.-H.
Hsiao C.-F
Hsiung C.A
Liu T.-W
Chuang M.-H
Wu H.-Y
Hsu Y.-T
Tsui C.-W
Taiwan Cooperative Oncology Group
Abstract
Background/Purpose: Hepatitis B virus (HBV) reactivation may occur in >10% of patients with lymphoma and resolved HBV infection who undergo rituximab-containing chemotherapy. Preventive strategies may have marked impact on resource allocation in HBV endemic areas. This study aims to compare the cost-effectiveness between prophylactic antiviral therapy and HBV DNA monitoring for the prevention of HBV-related complications. Methods: Data sources are studies of HBV-related events and survival for patients with lymphoma and resolved HBV infection published since 2006. Decision tree analysis was used to compare the incremental cost-effectiveness ratio (ICER) of preventing HBV-related death or liver decompensation for patients who undergo first-line rituximab-containing chemotherapy. Sensitivity analysis was performed to examine the impact of the preventive efficacy, the duration of prophylactic antiviral therapy, and the cost of different interventions. The direct medical cost was derived from the database of the NHI Administration, Taiwan. The time frame of our analysis was set to 3 years after the completion of chemotherapy. Results: The median ICER of prophylactic antiviral therapy, according to current practice guidelines, ranged between USD 150,000 and 250,000 if we apply the guidelines generally. When a long-course (12 months after completion of chemotherapy according to clinical guidelines) prophylactic therapy was assumed, Option A was cheaper and more effective only in the anti-HBs-negative subgroup (median ICER US$149,932 vs. US$161,526, p = 0.013). Conclusion: Identification of anti-HBs-negative subgroups is critical to improve the cost-effectiveness of prophylactic antiviral therapy in lymphoma patients with resolved HBV infection. ? 2019 Formosan Medical Association
SDGs
Other Subjects
cyclophosphamide plus doxorubicin plus prednisolone plus rituximab plus vincristine; hepatitis B surface antibody; antineoplastic agent; antivirus agent; hepatitis B antibody; hepatitis B surface antigen; rituximab; virus DNA; antiviral therapy; Article; cancer chemotherapy; cancer patient; cancer survival; chemotherapy; clinical outcome; clinical study; cost effectiveness analysis; decompensated liver cirrhosis; diffuse large B cell lymphoma; disability-adjusted life year; endemic disease; follow up; hepatitis B; Hepatitis B virus; hospital patient; human; human tissue; liver biopsy; national health insurance; nonhuman; outcome assessment; overall survival; population; practice guideline; prophylaxis; resource allocation; survival; treatment duration; virus reactivation; World Health Organization; blood; chronic hepatitis B; complication; cost benefit analysis; nonhodgkin lymphoma; Taiwan; virus activation; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Cost-Benefit Analysis; DNA, Viral; Hepatitis B Antibodies; Hepatitis B Surface Antigens; Hepatitis B, Chronic; Humans; Lymphoma, Non-Hodgkin; Rituximab; Taiwan; Virus Activation
Publisher
Elsevier B.V.
Type
journal article