Skill Nicholas J, Butler James, O'Brien Daniel C, Kays Joshua K, Kubal Chandrasekhar Avinash, Liangpunsakul Suthat, Ninad Nehal, Maluccio Mary A
Indiana University School of Medicine, Indianapolis, Indiana.
Indiana University School of Medicine, Indianapolis, Indiana.
Transplant Proc. 2019 Jul-Aug;51(6):1907-1912. doi: 10.1016/j.transproceed.2019.04.026.
Liver transplant and liver resection are surgical treatments for hepatocellular carcinoma (HCC) performed with curative intent. While liver transplant provides longer survival when compared to resection, the financial burden on patients and payors is significantly greater. With the increase in health care costs and the emergence of high deductible insurance policies that increase out of pocket deductibles for patients, assessment of value-based treatment is warranted.
We compiled total billable events from diagnosis of HCC through resection (N = 20) or transplant (N = 24) to death or last reported encounter from January 2011 to December 2012.
Patients with HCC receiving resection had a model of end stage liver disease of 10.2 ± 1.2, survival 652 days (3-1, 167 days), and billable encounters of $316,873 ($2904/day). HCC patients receiving a liver transplant had a greater liver injury (model of end stage liver disease of 19.2 ± 3.7), longer survival (1579 days), and higher billable encounters, $740,714 ($2889/day). The surgical procedure represented the largest cost category (28% and 26% resection vs transplant, respectively). The cost effectiveness of treatment was directly proportional to length of survival. In resection, patients who survived >30 days (85%) cost per day dropped to $432. Transplant patients who survived >2 years (75%) saw the cost per day drop to $462.
The relative financial burdens of liver resection vs liver transplant for treating HCC are comparable in patients who survive beyond a certain threshold. Transplant patients survived longer, and survival beyond 2 years makes this approach cost effective. In a health care climate aiming to contain costs and evaluate value-based treatment paradigms, expected survival and financial burden should be included in the treatment decision analysis.
肝移植和肝切除术是针对肝细胞癌（HCC）实施的具有治愈目的的外科治疗方法。与肝切除术相比，肝移植能带来更长的生存期，但患者和支付方的经济负担要大得多。随着医疗保健成本的增加以及高免赔额保险政策的出现，这类政策增加了患者的自付免赔额，因此有必要对基于价值的治疗进行评估。
我们汇总了2011年1月至2012年12月期间从肝癌诊断到肝切除（N = 20）或肝移植（N = 24）直至死亡或最后一次报告就诊情况的全部可计费事件。
接受肝切除的肝癌患者终末期肝病模型评分为10.2±1.2，生存期为652天（3 - 1,167天），可计费就诊费用为316,873美元（2,904美元/天）。接受肝移植的肝癌患者肝损伤更严重（终末期肝病模型评分为19.2±3.7），生存期更长（1,579天），可计费就诊费用更高，为740,714美元（2,889美元/天）。手术操作是最大的成本类别（肝切除和肝移植分别占28%和26%）。治疗的成本效益与生存期直接相关。在肝切除组中，存活超过30天的患者（85%）每日费用降至432美元。存活超过2年的肝移植患者（75%）每日费用降至462美元。
对于生存期超过一定阈值的患者，肝切除与肝移植治疗肝癌的相对经济负担相当。肝移植患者生存期更长，超过2年的生存期使这种治疗方法具有成本效益。在旨在控制成本和评估基于价值的治疗模式的医疗环境中，治疗决策分析应考虑预期生存期和经济负担。
