Cost of Hepatocellular Carcinoma from the Payer’s Perspective in Türkiye: Results of a Delphi Panel Analysis
Authors:   Department Of Medical Oncology, Altunizade Acıbadem Hospital, İstanbul, Türkiye, Faysal Dane , Mehtap Tatar ,   Polar Health Economics And Policy, Ankara, Türkiye, Erdem Göker ,   Department Of Medical Oncology, Ege University Faculty Of Medicine, İzmir, Türkiye, Birol Yıldız ,   Department Of Medical Oncology, Medical Park Hospital, Elazığ, Türkiye, Sezer Sağlam ,   Department Of Medical Oncology, Gayrettepe Florence Nightingale Hospital, İstanbul, Türkiye, Mustafa Karaca ,   Department Of Medical Oncology, Antalya Training And Research Hospital, Antalya, Türkiye, Mesut Şeker ,   Department Of Medical Oncology, Bezmialem Vakif University Hospital, İstanbul, Türkiye, Ali Şendur Mehmet ,   Department Of Medical  Oncology, Ankara Yildirim Beyazıt University Faculty Of Medicine, Ankara, Türkiye, Feyza Dilber ,   Department Of Gastroenterology, Bezmialem Vakıf University Hospital, İstanbul, Türkiye, Şahin Laçin ,   Department Of Medical Oncology, Koç University Faculty Of Medicine, İstanbul, Türkiye, Ender Dulundu ,   Department Of Surgery, Istanbul University Cerrahpasa Faculty Of Medicine, İstanbul, Türkiye, Fatih Köse ,   Department Of Medical Oncology, Başkent University Faculty Of Medicine, Adana, Türkiye, Deniz Aydoğan ,   Roche Müstahzarları Sanayi Anonim Şirketi, İstanbul, Türkiye, Buket Öztürk ,   Roche Müstahzarları Sanayi Anonim Şirketi, İstanbul, Türkiye, Şuayip Yalçın ,   Department Of Medical Oncology, Hacettepe University Faculty Of Medicine, Ankara, Türkiye
Published: September 2024

Background: Liver cancer is the sixth most frequently diagnosed cancer in the world ranking third in cancer related deaths. Hepatocellular carcinoma (HCC) accounts for 75-80% of liver cancers. Despite a decrease in cases of Hepatitis B (HBV) and Hepatitis C (HCV) in recent years, it is predicted that HCC will continue to increase primarily due to the burden imposed by other risk factors such as obesity, type 2 diabetes and non-alcoholic fatty liver disease (NAFLD). Financial data regarding the cost burden of a disease on a reimbursement agency is crucial for predicting the impact of disease trends in the future. Aim: This study aim to estimate the financial burden of HCC on the Social Security Institution (SSI) of Türkiye. Methodology: The data needed to estimate the cost of HCC was gathered through expert opinions. The Modified Delphi Method was used to reach a consensus among experts. A Healthcare Resource Utilization (HRU) form was designed and sent to experts to be filled out independently. Twelve experts were selected through purposeful sampling (one general surgeon, one hepatologist and ten medical oncologists). The answers from the first round were consolidated as averages, and a consensus document was prepared. This document was then discussed in a face-to-face meeting with the experts, and the consensus-building process was finalized. The costs were estimated by using the rules and reimbursement prices of the SSI. Results: The annual cost per patient for unresectable HCC was estimated as 1,056,396 TRY (US$32,937) for the first line treatment and 495,342TRY (US$15,144) for the second line treatment. The annual cost per patient for resectable HCC was estimated as 18,614TRY (US$580). The total cost of HCC to the SSI was estimated as 2,178,840,160 TRY (US$67,933,569) for unresectable cases and 37,082,609TRY (US$1,156,190) for resectable cases. This accounted for 0.4% of total SSI expenditures. Conclusion: Increasing risk factors such as obesity, type 2 diabetes and NAFLD in Türkiye may result in an increase in HCC cases. Our findings indicate the need to consider the potential burden of HCC on the SSI budget in the future.