Tapper Elliot B, Catana Andreea M, Sethi Nidhi, Mansuri Daniel, Sethi Saurabh, Vong Annie, Afdhal Nezam H
Division of Gastroenterology/Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Cancer. 2016 Mar 15;122(6):852-8. doi: 10.1002/cncr.29855. Epub 2015 Dec 30.
Hepatitis C virus (HCV) is the commonest cause of hepatocellular carcinoma (HCC) in the United States. The benefits of HCV therapy may be measured in part by the prevention of HCC and other complications of cirrhosis. The true cost of care of the HCV patient with HCC is unknown.
One hundred patients were randomly selected from a cohort of all HCC patients with HCV at a US transplant center between 2003 and 2013. Patients were categorized by the primary treatment modality, Barcelona class, and ultimate transplant status. Costs included the unit costs of procedures, imaging, hospitalizations, medications, and all subsequent care of the HCC patient until either death or the end of follow-up. Associations with survival and cost were assessed in multivariate regression models.
Overall costs included a median of $176,456 (interquartile range [IQR], $84,489-$292,192) per patient or $6279 (IQR, $4043-$9720) per patient-month of observation. The median costs per patient-month were $7492 (IQR, $5137-$11,057) for transplant patients and $4830 for nontransplant patients. The highest median monthly costs were for transplant patients with Barcelona A4 disease ($11,349) and patients who received chemoembolization whether they underwent transplantation ($10,244) or not ($8853). Transarterial chemoembolization and radiofrequency ablation were independently associated with a 28% increase and a 22% decrease in costs, respectively, with adjustments for the severity of liver disease and Barcelona class.
These data represent real-world estimates of the cost of HCC care provided at a transplant center and should inform economic studies of HCV therapy.
丙型肝炎病毒（HCV）是美国肝细胞癌（HCC）最常见的病因。HCV治疗的益处部分可通过预防HCC和肝硬化的其他并发症来衡量。HCV合并HCC患者的实际护理成本尚不清楚。
从2003年至2013年美国一家移植中心的所有HCV相关HCC患者队列中随机选取100例患者。患者按主要治疗方式、巴塞罗那分期和最终移植状态进行分类。成本包括手术、影像学检查、住院、药物治疗以及HCC患者直至死亡或随访结束的所有后续护理的单位成本。在多变量回归模型中评估与生存和成本的关联。
总体成本中位数为每位患者176,456美元（四分位间距[IQR]，84,489 - 292,192美元）或每位患者每月观察期6279美元（IQR，4043 - 9720美元）。移植患者每位患者每月的成本中位数为7492美元（IQR，5137 - 11,057美元），非移植患者为4830美元。每月成本中位数最高的是巴塞罗那A4期疾病的移植患者（11,349美元）以及接受化疗栓塞的患者，无论其是否接受移植（接受移植的为10,244美元，未接受移植的为8853美元）。经动脉化疗栓塞和射频消融分别与成本增加28%和降低22%独立相关，并对肝病严重程度和巴塞罗那分期进行了调整。
这些数据代表了移植中心提供的HCC护理成本的真实世界估计，应为HCV治疗的经济学研究提供参考。
