Cost-effectiveness of managing HBV reactivation in patients with resolved HBV infection treated with anti-CD20 antibody for B-cell non-Hodgkin lymphoma

• Published in: Scientific reports Vol. 12; no. 1; p. 7365
• Main Authors: Fujita, Misuzu, Kusumoto, Shigeru, Ishii, Itsuko, Iwata, Tadashi, Fujisawa, Takehiko, Sugiyama, Masaya, Hata, Akira, Mizokami, Masashi
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 05-05-2022; Nature Publishing Group; Nature Portfolio
• Subjects: 692/699/1503/234; 692/700/3934; Antiviral agents; CD20 antigen; Cost analysis; Cost-Benefit Analysis; Deoxyribonucleic acid; DNA; DNA, Viral; Hepatitis B virus; Humanities and Social Sciences; Humans; Lymphocytes B; Lymphoma; Lymphoma, Non-Hodgkin - drug therapy; Monoclonal antibodies; multidisciplinary; Non-Hodgkin's lymphoma; Quality-Adjusted Life Years; Science; Science (multidisciplinary); Sensitivity analysis
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-022-10665-3

There is no universal recommendation for managing the reactivation of HBV in patients with resolved HBV infection treated with anti-CD20 monoclonal antibodies for B-cell non-Hodgkin lymphoma. This study compared the cost-effectiveness of two commonly used strategies: prophylactic anti-HBV nucleos(t)ide analog therapy (Pro NAT), and HBV DNA monitoring followed by on-demand antiviral therapy (HBV DNA monitoring). Using a decision tree model, the incremental cost-effectiveness ratio (ICER) expressed as cost per quality-adjusted life-year (QALY) gained was calculated. The threshold for cost-effectiveness was set at 5,000,000 JPY, equivalent to 45,662 USD. In a base–case analysis, HBV DNA monitoring was found to be more cost-effective based on the calculation of ICER as 132,048 USD per QALY, a value that far exceeds 45,662 USD. The same results were consistently obtained by a one-way deterministic sensitivity analysis, even after changing each parameter value within the predetermined range. A probabilistic sensitivity analysis with 10,000 simulations also revealed that HBV DNA monitoring is more cost-effective than Pro NAT in 96.8% of cases. Therefore, this study suggests that HBV DNA monitoring is an appropriate managing measure in Japan from a cost-effectiveness perspective.