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Liver transplant, cancer stage increase HCC care costs, survival time

A recently published analysis of veterans with hepatocellular carcinoma showed that receipt of liver transplantation, Barcelona Clinic Liver Cancer stage and multidisciplinary tumor board correlated with higher 3-year health care costs but increased survival time.

“HCC care consumes tremendous healthcare resources, likely higher than previously estimated,” David E. Kaplan, MD, MSc, a gastroenterologist at University of Pennsylvania and Philadelphia VA Medical Center, and colleagues wrote. “As HCC incidence increases and more expensive interventions are developed, the burden HCC places on U.S. healthcare will increase. The cost-effectiveness of therapies that can prevent HCC development by reducing progression to cirrhosis or by detecting cancer at earlier, curative stages should be re-evaluated in the context of these new comprehensive measurements of HCC-related costs.”

The researchers compared 3,183 patients with confirmed HCC against 12,722 controls with cirrhosis matched for age and Child-Turcotte Pugh stage. The average 3-year total cost of health care among the HCC cohort was $154,688 (range, $150,953-$158,422) vs. $69,010 (range, $67,344-$70,675) for the control group, representing an incremental cost of $85,679 and exceeding the average 3-year health care costs for veterans by $129,500.

Compared with controls, 67% of the cost increment for patients with HCC arose from inpatient costs, with a mean difference of $55,619.

The average total 3-year health care costs for 92 patients who received liver transplantation was $539,955 (95% CI, 465,300-614,610), compared with $117,948 among controls (95% CI, 101,641-134,256), for a difference of $422,007 relative to controls and $396,735 relative to patients with HCC who did not undergo liver transplantation.

For patients with Barcelona Clinic Liver Cancer (BCLC) stages 0 through C, between 61.9% and 65.4% of total costs corresponded to inpatient services compared with 81% among patients with BCLC stage D. Average per-patient-per-year cost showed a steady increase along with stage from $136,759 for BCLC stage 0 and $132,764 for stage A, to $178,470 for stage B, $269,312 for stage C, and $466,758 for stage D.

A predictive model designed by the researchers showed an association between liver transplantation and greatest incremental cost, with an average additional $365,645 over non-transplant care. While multidisciplinary tumor board correlated with a small but significant cost increase, improved survival in each stage of BCLC after stage A resulted in significantly reduced per-patient-per-year cost.

“Management of cases at a hospital with academic affiliation resulted in longer survival, associated with slightly lower costs in early stage disease, but higher costs in intermediate to late stage disease, and equivalent costs in BCLC D,” the researchers wrote. “This model may be of use for health systems and third-party payers for predicting the impact of increased HCC incidence anticipated during the next decade on future liver disease–related costs.” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.