Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Ontario Institute for Cancer Research/Cancer Care Ontario, Toronto, Ontario, Canada.
Hepatology. 2013 Oct;58(4):1375-84. doi: 10.1002/hep.26231. Epub 2013 Mar 15.
Although the burden of hepatocellular carcinoma (HCC) is an escalating public health problem, it has not been rigorously estimated within a Canadian context. We conducted a population-based study using Ontario Cancer Registry linked administrative data. The mean net costs of care due to HCC were estimated using a phase of care approach and generalized estimating equations. Using an incidence approach, the mean net costs of care were applied to survival probabilities of HCC patients to estimate 5-year net costs of care and extrapolated to the Canadian population of newly diagnosed HCC patients in 2009. During 2002-2008, 2,341 HCC cases were identified in Ontario. The mean (95% confidence interval [CI]) net costs of HCC care per 30 patient-days (2010 US dollars) were $3,204 ($2,863-$3,545) in the initial phase, $2,055 ($1,734-$2,375) in the continuing care phase, and $7,776 ($5,889-$9,663) in the terminal phase. The mean (95% CI) 5-year net cost of care was $77,509 ($60,410-$94,607) and the 5-year aggregate net cost of care was $106 million ($83-$130 million) (undiscounted). The net costs of patients receiving liver transplantation only and those undergoing surgical resection only were highest in the terminal phase. The net cost of patients receiving radiofrequency ablation as the only treatment was relatively low in the initial phase, and there were no significant differences in the continuing and terminal phases.
Our findings suggest that costs attributable to HCC are significant in Canada and expected to increase. Our findings of phase-specific cost estimates by resource categories and type of treatment provide information for future cost-effectiveness analysis of potential innovative interventions, resource allocation, and health care budgeting, and public health policy to improve the health of the population.
虽然肝细胞癌 (HCC) 的负担是一个不断加剧的公共卫生问题，但在加拿大的背景下尚未进行严格估计。我们使用安大略癌症登记处链接的行政数据进行了一项基于人群的研究。使用阶段治疗方法和广义估计方程估计了由于 HCC 导致的护理平均净成本。使用发病率方法，将护理的平均净成本应用于 HCC 患者的生存概率，以估计 5 年的护理净成本，并外推到 2009 年加拿大新诊断 HCC 患者的人群中。在 2002-2008 年期间，在安大略省确定了 2341 例 HCC 病例。每 30 个患者日（2010 年美元）的 HCC 护理平均（95%置信区间 [CI]）净成本在初始阶段为 3204 美元（2863-3545 美元），在持续护理阶段为 2055 美元（1734-2375 美元），在终末期为 7776 美元（5889-9663 美元）。护理的平均（95%CI）5 年净成本为 77509 美元（60410-94607 美元），5 年总净成本为 1.06 亿美元（8300 万-1.30 亿美元）（未贴现）。仅接受肝移植和仅接受手术切除的患者的净成本在终末期最高。仅接受射频消融治疗的患者的净成本在初始阶段相对较低，在持续和终末期没有显着差异。
我们的研究结果表明，加拿大归因于 HCC 的成本很高，预计还会增加。我们按资源类别和治疗类型划分的特定阶段成本估算结果为未来潜在创新干预措施、资源分配和医疗保健预算以及改善人口健康的公共卫生政策的成本效益分析提供了信息。
