Direct costs of care for hepatocellular carcinoma in patients with hepatitis C cirrhosis

作者：Tapper Elliot B^*; Catana Andreea M; Sethi Nidhi; Mansuri Daniel; Sethi Saurabh; Vong Annie; Afdhal Nezam H

来源：Cancer, 2016, 122(6): 852-858.

DOI：10.1002/cncr.29855

• liver cancer
• liver disease
• liver transplant
• tumor
• viral hepatitis

BACKGROUNDHepatitis C virus (HCV) is the commonest cause of hepatocellular carcinoma (HCC) in the United States. The benefits of HCV therapy may be measured in part by the prevention of HCC and other complications of cirrhosis. The true cost of care of the HCV patient with HCC is unknown.
METHODSOne hundred patients were randomly selected from a cohort of all HCC patients with HCV at a US transplant center between 2003 and 2013. Patients were categorized by the primary treatment modality, Barcelona class, and ultimate transplant status. Costs included the unit costs of procedures, imaging, hospitalizations, medications, and all subsequent care of the HCC patient until either death or the end of follow-up. Associations with survival and cost were assessed in multivariate regression models.
RESULTSOverall costs included a median of $176,456 (interquartile range [IQR], $84,489-$292,192) per patient or $6279 (IQR, $4043-$9720) per patient-month of observation. The median costs per patient-month were $7492 (IQR, $5137-$11,057) for transplant patients and $4830 for nontransplant patients. The highest median monthly costs were for transplant patients with Barcelona A4 disease ($11,349) and patients who received chemoembolization whether they underwent transplantation ($10,244) or not ($8853). Transarterial chemoembolization and radiofrequency ablation were independently associated with a 28% increase and a 22% decrease in costs, respectively, with adjustments for the severity of liver disease and Barcelona class.
CONCLUSIONSThese data represent real-world estimates of the cost of HCC care provided at a transplant center and should inform economic studies of HCV therapy. Cancer 2016;122:852-8. (c) 2015 American Cancer Society.
The economics of hepatitis C therapy needs real-world estimates of the cost of hepatocellular carcinoma treatment. This study of 100 randomly selected patients with hepatitis C cirrhosis demonstrates a median cost of $176,456 per patient ($6279 per patient-month).

• 出版日期2016-3-15