Division of Gastroenterology, Pin-Tung Christian Hospital, Pin-Tung 900, Taiwan.
Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan.
Int J Environ Res Public Health. 2018 Nov 26;15(12):2655. doi: 10.3390/ijerph15122655.
Hepatitis B virus vaccination and antiviral therapies reduce the risk of hepatocellular carcinoma (HCC). However, the lifetime healthcare expenditure involved in caring for HCC patients remains unclear. We examined the use and direct costs of healthcare services for a cohort of HCC patients to the healthcare system using Taiwan national health insurance program research database between 1997 and 2012. Total medical cost for all reimbursed patient encounters, including hospitalizations and outpatient care was cumulated from HCC onset to the end of follow-up or death. The mean follow-up time was 2.7 years (standard deviation, SD = 3.3) for the entire HCC cohort. Insurance payments of approximately US$92 million were made to 5522 HCC patients, with a mean cost of US$16,711 per patient (21,350). On average, the total cost per patient per month was US$2143 (5184); it was 50% higher for advanced cirrhosis patients at the baseline but 23% lower for mild-to-moderate cirrhotic patients. In the two-part regression, patients' underlying comorbid conditions, liver transplants, hepatectomy, and transarterial chemoembolization were associated with increased total cost, with liver transplants having the greatest impact over time. Hepatocellular carcinoma imposes substantial burden on the healthcare system. Real-world evidence on treatment and cost outcomes highlighted the needs to expand effective screening strategies and to optimize healthcare delivery to meet HCC patients' clinical needs.
乙型肝炎病毒疫苗接种和抗病毒治疗可降低肝细胞癌（HCC）的风险。然而，用于治疗 HCC 患者的终生医疗保健支出尚不清楚。我们使用台湾全民健康保险计划研究数据库，从 1997 年到 2012 年，对 HCC 患者向医疗体系使用的医疗服务和直接医疗成本进行了检查。从 HCC 发病到随访结束或死亡，累计了所有报销患者就诊的全部医疗费用，包括住院和门诊护理。整个 HCC 队列的平均随访时间为 2.7 年（标准差，SD = 3.3）。为 5522 名 HCC 患者支付了约 9200 万美元的保险金，每位患者的平均费用为 16711 美元（21350 新台币）。平均而言，每位患者每月的总成本为 2143 美元（5184 新台币）；基线时，晚期肝硬化患者的费用增加了 50%，但轻度至中度肝硬化患者的费用降低了 23%。在两部分回归中，患者的基础合并症、肝移植、肝切除术和经动脉化疗栓塞与总费用的增加有关，随着时间的推移，肝移植的影响最大。肝细胞癌给医疗体系带来了巨大负担。关于治疗和成本结果的真实世界证据强调了扩大有效筛查策略和优化医疗服务以满足 HCC 患者临床需求的必要性。
