Financial impact of hepatitis B screening for subsequent chemotherapy
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Publication Date
4-29-2026
Keywords
oregon, psvmc, psvmc gme, psvmc oaa, ppmc, ppmc gme, ppmc gme pharmacy
Disciplines
Medical Education
Abstract
Abstract: The American Society of Clinical Oncology (ASCO) released an opinion that all patients on systemic anticancer therapy should be tested for hepatitis B virus (HBV) but gave no formal guidance on additional HBV testing if the initial HBV test is negative. It is unknown whether performing these tests is resulting in significant costs. The aim of this retrospective chart review is to determine the cost associated with HBV testing through various definitions of “unnecessary testing”. The rates of new potentially actionable HBV tests during retesting defined by HBV core antibody and surface antigen positive will also be determined. This is a multi-center, retrospective chart review that was performed across 4 Providence Health Plan oncology clinics in Oregon. Electronic medical records of patients with a chemotherapy treatment plan between May 2025-July 2025 were reviewed. The data collected were demographics (age, gender, ethnicity, type of cancer), HBV test results (for all tests performed), line of treatment (1st, 2nd, 3rd , etc), time each test was taken, and the use of a CD20 chemotherapy medication. For the results, the cost per test was multiplied by the number of tests that were determined to be unnecessary, through various definitions, and compared to the cost of all tests performed. Rates of new potentially actionable HBV tests were also calculated. A total of 565 patient charts were reviewed, and there were 265 new hepatitis B tests performed. This correlates to a cost of $25,600. On average, the time between treatments, when a new test was performed, was about 25 months compared to about 10 months between treatments when new tests were not done. When looking at patients who had a potentially actionable hepatitis B test result, there were 5 total patients (< 1%) who were not on CD20 therapy that had a new potentially actionable HBV test. Of these 5 patients, there were no consistent patterns in patient demographics, chemotherapy regimen, or type of cancer that would increase one’s risk of having a new potentially actionable HBV result. From this data, we cannot recommend changing the current practice regarding repeating hepatitis B testing. The inherent risk of having a new potentially actionable hepatitis B result still exists for all patients, on CD20 therapy or not. The monetary cost of missing a new potentially actionable result and the complications that may arise leading to a hospital admission outweigh the cost of our current practice for repeat HBV testing. (IRB exempt) Learning Objectives: Determine the financial impact of subsequent HBV testing through various definitions of “unnecessary testing”. Presentation Category: Medication Safety/Quality Improvement
Specialty/Research Institute
Graduate Medical Education
Specialty/Research Institute
Pharmacy
