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Hepatitis B prophylaxis in patients undergoing chemotherapy for lymphoma: A decision analysis model
Author(s) -
Saab Sammy,
Dong Mamie H.,
Joseph Tom A.,
Tong Myron J.
Publication year - 2007
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.21783
Subject(s) - lamivudine , medicine , chemotherapy , hepatitis b , hepatitis b virus , lymphoma , hepatitis , hepatology , surgery , intensive care medicine , immunology , virus
Hepatitis B reactivation is a major cause of morbidity and mortality in patients undergoing chemotherapy for lymphomas. These patients may experience direct liver‐related complications or reduced cancer survival because of interruptions in chemotherapy. Our aim was to compare the costs and outcomes of 2 different chronic hepatitis B management strategies. In hepatitis B carriers undergoing chemotherapy, we pursued a decision analysis model to compare the costs and clinical outcomes of using lamivudine prophylaxis versus initiating lamivudine only when clinically overt hepatitis occurred. Our results indicate that the use of lamivudine prophylaxis is cost‐effective. Even though the use of lamivudine prophylaxis was associated with an incremental cost of $1530 per patient ($18,707 versus $17,177), both the number and severity of hepatitis B reactivations were reduced. None of the patients in the prophylaxis group had liver‐related deaths versus 20 who died in the no‐prophylaxis group. Cancer deaths were also reduced from 47‐39 with lamivudine prophylaxis, presumably because of the increased need for cessation or modification of chemotherapy in patients who had severe hepatitis B virus flares. The incremental cost‐effectiveness ratio of using lamivudine prophylaxis was $33,514 per life year saved. Conclusion: Our results provide pharmacoeconomic support for the use of lamivudine prophylaxis in patients undergoing chemotherapy for lymphoma treatment. (H EPATOLOGY 2007.)