Direct cost of care for HCC higher in patients with HCV who underwent liver transplant

BOSTON — Cost of care for hepatocellular carcinoma, or HCC, was higher among patients with HCC and hepatitis C virus infection who underwent liver transplantation compared with patients who did not undergo transplant, according to data presented at The Liver Meeting.

“Transplantation is associated with longer survival and higher costs,” Andreea M. Catana, MD, of Beth Israel Deaconess Medical Center, Boston, said during her presentation.

Researchers randomly selected 101 patients (mean age 59 years) with HCC and HCV seen between 2003 and 2013 at the Beth Israel Deaconess Medical Center. Patients were divided into groups based on primary treatment for HCC: TACE (26%), Cyberknife radiotherapy (10%), radiofrequency ablation (53%), chemotherapy (2%) or resection (8%). Direct costs included the cost of the procedure, imaging, hospitalizations and all medical care of the HCC patient through transplant or death. HCV treatment and immunosuppression costs post-transplant were also included as direct costs. The costs were taken from the Medicare fee schedule from the HCUP National Inpatient Sample 2011 (HCUP procedure codes), according to the research.

The overall cost of HCC care for all of the patients was $22,030,108, with a mean cost of $218,120 per patient. Forty-three patients underwent liver transplant and had an overall cost per patient of $395,000. Overall costs for all transplant patients was $17,025,037 compared with $5,817,300 for the patients who did not undergo liver transplant. The mean cost per patient who did not have a transplant was $100,299.

Liver staging using the Barcelona score showed most patients had A4 (27%, B 12% and C 7%), then 20% for A1, 18% for A2 and 16% for A3.

“Costs are highest for patients with A4 class HCC,” Catana said during her presentation. “The specific costs downstream of TACE therapy should be further explored…further studies are needed to confirm these results.”

For more information:

Catana AM. Abstract 78. Presented at: The Liver Meeting; Nov. 7-11, 2014; Boston.

Disclosure: See the abstract for a full list of relevant financial disclosures.