Treatment patterns and costs of care for patients diagnosed with hepatocellular carcinoma (HCC) in the United States (U.S.)
Authors: L. Hess, Z. Cui, X. Li, Y. Wu, A. Girvan, P. Abada
Journal: Annals of Oncology (2018)

Introduction: Cost considerations are increasingly becoming important in the care of patients with HCC, and may influence treatment decision making. The objective of this study was to describe treatment patterns and evaluate the direct medical costs of HCC to patients and third-party payers. Methods: This retrospective cohort study analyzed de-identified data from the Truven MarketScan database, which contains longitudinal claims data from more than 175 million patients in the USA. Patients aged 18 or older, initially diagnosed with HCC (identified by ICD-9 and ICD-10 codes) between 2008-2015, with continuous enrolment from 6 months prior through ≥1 month following HCC diagnosis, received anti-cancer systematic therapy, and had no evidence of liver sarcomas or other cancer diagnoses were eligible for this study. Adjusted for inflation and reported in 2015 US dollars using medical care component of the Consumer Price Index. Descriptive and logistic regression analyses were conducted using SAS v9.2. Results: A total of 2285 patients were eligible for inclusion: 75.8% male, median age 61 years, 23.7% with evidence of metastatic disease at diagnosis. 1190 (52.1%) patients received first-line sorafenib; as expected, patients who received sorafenib were more likely to be older, insured with Medicare, have metastatic disease, and without liver disease, hepatitis C or cirrhosis than those who did not (all p ≤ 0.001). Only 18.8% of patients treated with first-line sorafenib received second-line treatment. Concomitant health care use after HCC diagnosis in the study cohort included supportive care (92.5%), pain medications (84.8%), transarterial chemoembolization (52.3%), hepatitis treatments (51.5%), antidepressants (46.9%), and hospice care (27.8%). Hospitalizations occurred in 74.7% of patients (average stay 14 days), and 53.2% had at least one emergency room visit. Patient out-of-pocket costs for first-line treatment were right-skewed (median US$478.50, range $0-$184,818.37), as were third-party payer costs (median US$35,411.96, range $0-983,355.19). Total median costs of care for patients after initial diagnosis through end of follow up was $4431.62 (patient out-of-pocket costs) and $158,057.33 (third-party payer costs). Average monthly patient out-of-pocket ($507.71 vs $618.95) and third-party payer costs ($18,822.45 vs $26,376.53) have both significantly increased over time (patients diagnosed in 2008 vs 2015 respectively, both p < 0.0001). Factors associated with higher total all-cause patient out-of-pocket costs included older age, longer time from diagnosis to first-line therapy, and higher number of concomitant medications (all p < 0.0001). Factors associated with higher total all-cause payer costs included pre-systematic therapy radiation (p = 0.005) or surgery (p < 0.001) and higher number of concomitant drugs (p < 0.0001), presence of cirrhosis (p = 0.0003), longer time to first-line therapy (p = 0.0004), presence of hepatitis C (p = 0.008), male gender (p = 0.005), and having commercial insurance (p = 0.01). Total costs of care for patients diagnosed with HCC and for payers are increasing at an average annual rate of 2 and 3.4%, respectively. Conclusion: Costs of care for patients diagnosed with HCC are increasing, despite the small proportion of patients receiving additional therapy post-progression on sorafenib. The majority of HCC patients receive supportive care and experience hospitalizations and emergency room care; there is a need for more effective treatments that are better able to manage the impact of the disease on patients.