The cost of treating hepatocellular carcinoma (HCC) in patients with hepatitis C cirrhosis is very high — more than $175,000 per patient, according to a study published in the journal Cancer, titled “Direct costs of care for hepatocellular carcinoma in patients with hepatitis C cirrhosis.”
Hepatitis C virus (HCV) is a common cause of hepatocellular carcinoma (HCC), and an increasing problem in the U.S. Antiviral therapies are known to reduce the burden of HCV and, subsequently, the incidence of HCC, but the full costs of care have not been studied.
“Two of the principle drivers of the cost of care for patients with chronic HCV are the complications of decompensated cirrhosis and HCC,” Elliott B. Tapper, MD, a clinical fellow in medicine at Beth Israel Deaconess Medical Center, said in a news release. “HCV therapy, therefore, presented a tradeoff. The upfront costs of viral eradication could be offset by the prevention and cost of complications in the long run. Accordingly, data are needed on the true costs of HCC care to structure realistic cost-effectiveness models.”
Researchers randomly selected a cohort of 100 HCC patients with HCV treated at a U.S. transplant center between 2003 and 2013. Patients were categorized by primary treatment modality, Barcelona class, and ultimate transplant status. Costs included the unit costs of procedures, medications, hospitalizations, imaging, and all subsequent care of HCC patients, until the end of follow-up or death.
Results showed that the median costs were $176,456 per patient, which equated to $6,279 per patient-month of observation. The median costs per patient-month were $7,492 for transplant patients, and $4,830 for non-transplant patients.
The highest average monthly costs were for patients with Barcelona A4 disease ($11,349), followed by patients treated with chemoemobilization and who underwent liver transplantation ($10,244), while those who were treated with chemoemobilization but did not have a liver transplant had an average monthly cost of $8,853.
Transarterial chemoemobilization (TACE) was associated with a 28 percent increase in costs, and radiofrequency ablation was associated with 22 percent decrease in costs. Liver transplantation was found to increased costs by 30 percent.
Median overall survival (OS) for the entire group, and for transplant patients and nontransplant patients, was 27, 43 and 20 months, respectively.
Following transplantation, those patients who were treated with stereotactic body radiation had the longest average OS (64 months), whereas those who underwent TACE had the shortest at 32 months.
Among patients who did not received a transplant, those who underwent resection had the longest median OS (29 months) and those who were treated with stereotactic body radiation had the shortest OS (10 months).
“Our work extends the literature on HCC economics in important ways by providing patient-level data and contextualizing the costs by Barcelona class and first treatment modality,” Dr. Tapper said.
The study had several limitations, such as the non-inclusion of radioemobilization data costs, because during the study period this modality was not available at the center.
In addition, the patient cohort was from a transplant center in the northeastern U.S., where there is long waiting time for a liver transplant and a higher model for end-stage liver disease scores. With many patients going on to have a transplant, researchers noted their findings cannot be generalized to clinical practices that have no access to liver transplantation.
Furthermore, these results represent expenditures and not charges, which can vary widely.
In an accompanying editorial, “Pricey pills for an even pricier problem” Sharon W. Kwan, MD, from the University of Washington School of Medicine, said that this study and similar ones did not account for the greater cost of HCC — lost productivity and the impact of the disease on families and caregivers.
Cancer patients are at increased risk for bankruptcy, and, Dr. Kwan wrote, their caregivers report high rates of psychological distress. But, she acknowledged, the upfront costs of treating HCV infection are quite large.
“This affordability problem is a tremendous one and many payers should be applauded for their thoughtful efforts to maximize access to treatment within current budget constraints,” she wrote. “Nonetheless, as some payers continue to restrict access for certain patients, they must be mindful that ‘kicking the can down the road’ is not an acceptable solution when the proverbial can is a multibillion dollar one accompanied by unquantifiable human suffering and loss.”