January's issue of the Clinical Gastroenterology & Hepatology investigates healthcare costs related to treatment of hepatocellular carcinoma among Veterans with cirrhosis in the United States.
It is important to quantify medical costs associated with hepatocellular carcinoma (HCC), the incidence of which is rapidly increasing in the United States, for development of rational healthcare policies related to liver cancer surveillance and treatment of chronic liver disease.
Dr David Kaplan and colleagues aimed to comprehensively quantify healthcare costs for HCC among patients with cirrhosis in an integrated health system and develop a model for predicting costs that is based on clinically relevant variables.
The research team noted that 3 years subsequent to liver cancer diagnosis, costs accrued by patients included in the Veteran’s Outcome and Cost Associated with Liver disease cohort were compiled by using the Department of Veterans Affairs Corporate Data Warehouse.
3-year total cost of care in HCC patients was $154,688
Clinical Gastroenterology & Hepatology
The cohort includes all patients with HCC diagnosed in 2008–2010 within the VA with 100% chart confirmation as well as chart abstraction of tumor and clinical characteristics.
Cancer cases were matched 1:4 with non-cancer cirrhosis controls on the basis of severity of liver disease, age, and comorbidities to estimate background cirrhosis-related costs.
The team's analysis included 3188 cases of HCC and 12,722 controls.
The researchers found that the mean 3-year total cost of care in HCC patients was $154,688 compared with $69,010 in matched cirrhotic controls, yielding an incremental cost of $85,679, and 65% of this value reflected increased inpatient costs.
The research team observed that receipt of transplantation, Barcelona Clinic Liver Cancer (BCLC) stage, liver disease etiology, hospital academic affiliation, use of multidisciplinary tumor board, and identification through surveillance were associated with cancer-related costs.
Multivariable generalized linear models incorporating transplantation status, BCLC stage, and multidisciplinary tumor board presentation accurately predicted liver cancer–related costs.
Dr Kaplan's team concludes, "In a model developed to comprehensively quantify healthcare costs for HCC among patients with cirrhosis in an integrated health system, we associated receipt of liver transplantation, BCLC stage, and multidisciplinary tumor board with higher costs."
"Models that predict total costs on the basis of receipt of liver transplantation were constructed and can be used to model cost-effectiveness of therapies focused on HCC prevention."
Summary: http://www.gastrohep.com/news/news.asp?id=112988
Clin Gastroenterol Hepatol 2018: 16(1): 106–114.e5
18 January 2018
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