The impact of a comprehensive policy change on the number of patients appropriately screened for HBV prior to administration of rituximab

Abstract

Specific Aims In patients with current or previous infection with the hepatitis B virus (HBV), immunosuppressive effects of rituximab can lead to viral reactivation of HBV. Screening patients for HBV prior to initiating rituximab is important in preventing reactivation. This project aims to examine the effects of a policy change on the rate of HBV screening. Methods A local system-wide policy change was implemented in April 2014 that provides criteria and requirements for HBV screening prior to the initiation of rituximab therapy. In this project, a retrospective chart review was performed to analyze the impact of the policy change on the rate of appropriate HBV screening. Only patients receiving rituximab for non-oncology indications were included in this project. All patients who received rituximab for cancer were excluded. Main Results In total, 253 patients were initiated on rituximab for non-oncology indications during the study period. The rate of screening for HBsAg increased from 24% before the policy change to 31% after the policy change (p=0.34). Similarly the rate of screening for HBcAb increased from 20% to 26% (p=0.42). Conclusions Although the findings were not statistically significant, the project remains important because similar studies have not targeted non-oncology indications for rituximab. This shows that policies with clearly stated criteria and requirements could potentially improve the rates of appropriate HBV screening across all medical subspecialties.