Hepatitis B virus screening before chemotherapy for lymphoma: a cost-effectiveness analysis

J Clin Oncol. 2012 Sep 10;30(26):3167-73. doi: 10.1200/JCO.2011.40.7510. Epub 2012 Jun 18.


Purpose: Hepatitis B virus (HBV) reactivation is a potentially fatal complication of chemotherapy that can be largely prevented with antiviral prophylaxis. It remains unclear whether HBV screening is cost effective.

Methods: A decision model was developed to compare the clinical outcomes, costs, and cost effectiveness of three HBV screening strategies for patients with lymphoma before R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy: screen all patients for hepatitis B surface antigen (HBsAg; Screen-All), screen patients identified as being at high risk for HBV infection (Screen-HR), and screen no one (Screen-None). Patients testing positive were administered antiviral therapy until 6 months after completion of chemotherapy. Those not screened were initiated on antiviral therapy only if HBV hepatitis occurred. Probabilities of HBV and lymphoma outcomes were derived from systematic literature review. A third-party payer perspective was adopted, costs were expressed in 2011 Canadian dollars, and a 1-year time horizon was used.

Results: Screen-All was the dominant strategy. It was least costly at $32,589, compared with $32,598 for Screen-HR and $32,657 for Screen-None. It was also associated with the highest 1-year survival rate at 84.99%, compared with 84.96% for Screen-HR and 84.86% for Screen-None. The analysis was sensitive to the prevalence of HBsAg positivity in the low-risk population, with Screen-HR becoming least costly when this value was ≤ 0.20%.

Conclusion: In patients receiving R-CHOP for lymphoma, screening all patients for HBV reduces the rate of HBV reactivation (10-fold) and is less costly than screening only high-risk patients or screening no patients.

Publication types

  • Evaluation Study

MeSH terms

  • Aged
  • Antibodies, Monoclonal, Murine-Derived / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects*
  • Cost-Benefit Analysis*
  • Cyclophosphamide / adverse effects
  • Decision Support Techniques
  • Doxorubicin / adverse effects
  • Early Diagnosis*
  • Hepatitis B / diagnosis*
  • Hepatitis B / economics*
  • Hepatitis B Surface Antigens / analysis
  • Hepatitis B virus
  • Humans
  • Lymphoma, Large B-Cell, Diffuse / drug therapy
  • Lymphoma, Large B-Cell, Diffuse / economics*
  • Lymphoma, Large B-Cell, Diffuse / virology*
  • Middle Aged
  • Prednisone / adverse effects
  • Rituximab
  • Treatment Outcome
  • Vincristine / adverse effects
  • Virus Activation / drug effects


  • Antibodies, Monoclonal, Murine-Derived
  • Hepatitis B Surface Antigens
  • R-CHOP protocol
  • Rituximab
  • Vincristine
  • Doxorubicin
  • Cyclophosphamide
  • Prednisone