Shankaran Veena, Chennupati Shasank, Sanchez Hayley, Sun Qin, Li Li, Fedorenko Catherine, Aly Abdalla, Healey Marcus, Seal Brian
Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Division of Medical Oncology, University of Washington, Seattle, WA, USA.
J Hepatocell Carcinoma. 2021 Dec 14;8:1597-1606. doi: 10.2147/JHC.S328274. eCollection 2021.
Though the treatment landscape for hepatocellular carcinoma (HCC) has evolved significantly with the refinement of liver-directed therapy techniques and the introduction of new drugs, few studies have investigated the impact of the changing treatment landscape on lifetime treatment costs, particularly in Barcelona Clinic Liver Cancer (BCLC) stage C disease. We sought to investigate real-world clinical characteristics, treatment patterns, and healthcare costs in a cohort of HCC patients treated at a single high-volume institution in Washington (WA) state.
We conducted a retrospective cohort study of patients diagnosed with HCC between 2007 and 2018 using abstracted electronic medical record (EMR) data linked to cancer registry data and health claims from commercial plans, Medicare, and Medicaid. We described clinical and treatment characteristics, including BCLC stage and Child Pugh score. We investigated median survival and mean lifetime treatment costs by BCLC stage using Kaplan-Meier cost estimator methods. A multivariate Cox proportional hazards model was used to investigate factors associated with overall survival.
The final cohort included 215 patients, the majority of whom were white (71%), male (68%), and with underlying hepatitis C (61%). Mean per patient lifetime costs were highest in BCLC A and BCLC C patients. Mean lifetime costs in BCLC A patients ($292,134) was driven by surgery, hospital, pharmacy, imaging, and outpatient costs. Chemotherapy costs were highest in BCLC C patients, though not the predominant area of spending. Median survival was highest in patients with BCLC 0 and A disease; BCLC stage C and higher area deprivation index (ADI) were associated with poorer survival.
In a cohort of WA state HCC patients, mean lifetime costs were highest in patients with BCLC A disease, attributable to surgery and hospital costs. As increased utilization of newer and less toxic therapies improves survival in BCLC C patients, mean lifetime costs in this group may also rise.
尽管随着肝导向治疗技术的完善和新药的引入，肝细胞癌（HCC）的治疗格局有了显著变化，但很少有研究调查治疗格局的变化对终身治疗成本的影响，尤其是在巴塞罗那临床肝癌（BCLC）C期疾病方面。我们试图调查华盛顿州一家大型机构治疗的一组HCC患者的真实世界临床特征、治疗模式和医疗成本。
我们对2007年至2018年期间诊断为HCC的患者进行了一项回顾性队列研究，使用了与癌症登记数据以及商业保险、医疗保险和医疗补助的健康理赔数据相关联的电子病历（EMR）摘要数据。我们描述了临床和治疗特征，包括BCLC分期和Child Pugh评分。我们使用Kaplan-Meier成本估计方法按BCLC分期调查中位生存期和平均终身治疗成本。使用多变量Cox比例风险模型调查与总生存期相关的因素。
最终队列包括215名患者，其中大多数为白人（71%）、男性（68%），且患有丙型肝炎（61%）。BCLC A期和BCLC C期患者的人均终身成本最高。BCLC A期患者的平均终身成本（292,134美元）由手术、住院、药房、影像和门诊成本驱动。BCLC C期患者的化疗成本最高，尽管不是主要支出领域。BCLC 0期和A期疾病患者的中位生存期最高；BCLC C期和更高的地区贫困指数（ADI）与较差的生存期相关。
在华盛顿州的一组HCC患者中，BCLC A期疾病患者的平均终身成本最高，这归因于手术和住院成本。随着更新且毒性较小的疗法使用增加改善了BCLC C期患者的生存期，该组患者的平均终身成本可能也会上升。
