Trends in Health Care Utilization and Costs Attributable to Hepatocellular Carcinoma, 2002–2009: A Population-Based Cohort Study

Thein, Hla-Hla; Qiao, Yao; Young, Shih‐Hao; Zarin, Wasifa; Yoshida, Eric M.; Oliveira, Claire de; Earle, Craig C.

doi:10.3747/co.23.2956

Cited by 9 publications

(16 citation statements)

References 41 publications

(51 reference statements)

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“…The OCR includes data for the date and stage of HCC diagnosis, age, sex, birth location, urban or rural residence, cause of death, and date of death. As in previous studies [ 18 – 21 ], we linked the OCR cohort to the Ontario Health Insurance Plan (OHIP) database, the Canadian Institute for Health Information Discharge Abstract Database, the Ontario Drug Benefit (ODB) program database, and the Canadian census data to provide person-level information on sociodemographic, screening, staging, treatment, and clinical factors. The OHIP physician billing claims contain service and diagnosis information for outpatient visits.…”

Section: Methodsmentioning

confidence: 99%

“…Where possible, hospitalization records from the date of diagnosis were used to assign each patient and control subject a baseline Charlson–Deyo comorbidity index. If patients did not have a hospitalization record at their diagnosis date, baseline comorbidity was determined by looking back 2 years into the hospitalization data to find the most recent hospitalization record; the comorbidity score from that hospitalization was then applied [ 18 – 21 ]. The Charlson–Deyo comorbidity index at baseline was marked as “missing” if the individual had no hospitalization records at diagnosis or during the 2 years before diagnosis.…”

Section: Methodsmentioning

confidence: 99%

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Cost-effectiveness analysis of treatment with non-curative or palliative intent for hepatocellular carcinoma in the real-world setting

et al. 2017

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Hepatocellular carcinoma (HCC) presentation is heterogeneous necessitating a variety of therapeutic interventions with varying efficacies and associated prognoses. Poor prognostic patients often undergo non-curative palliative interventions including transarterial chemoembolization (TACE), sorafenib, chemotherapy, or purely supportive care. The decision to pursue one of many palliative interventions for HCC is complex and an economic evaluation comparing these interventions has not been done. This study evaluates the cost-effectiveness of non-curative palliative treatment strategies such as TACE alone or TACE+sorafenib, sorafenib alone, and non-sorafenib chemotherapy compared with no treatment or best supportive care (BSC) among patients diagnosed with HCC between 2007 and 2010 in a Canadian setting. Using person-level data, we estimated effectiveness in life years and quality-adjusted life years (QALYs) along with total health care costs (2013 US dollars) from the health care payer’s perspective (3% annual discount). A net benefit regression approach accounting for baseline covariates with propensity score adjustment was used to calculate incremental net benefit to generate incremental cost-effectiveness ratio (ICER) and uncertainty measures. Among 1,172 identified patients diagnosed with HCC, 4.5%, 7.9%, and 5.6%, received TACE alone or TACE+sorafenib, sorafenib, and non-sorafenib chemotherapy clone, respectively. Compared with no treatment or BSC (81.9%), ICER estimates for TACE alone or TACE+sorafenib was $6,665/QALY (additional QALY: 0.47, additional cost: $3,120; 95% CI: -$18,800-$34,500/QALY). The cost-effectiveness acceptability curve demonstrated that if the relevant threshold was $50,000/QALY, TACE alone or TACE+sorafenib, non-sorafenib chemotherapy, and sorafenib alone, would have a cost-effectiveness probability of 99.7%, 46.6%, and 5.5%, respectively. Covariates associated with the incremental net benefit of treatments are age, sex, comorbidity, and cancer stage. Findings suggest that TACE with or without sorafenib is currently the most cost-effective active non-curative palliative treatment approach to HCC. Further research into new combination treatment strategies that afford the best tumor response is needed.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness analysis of treatment with non-curative or palliative intent for hepatocellular carcinoma in the real-world setting

et al. 2017

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“…Where possible, hospitalization records from the date of diagnosis were used to assign each patient and control subject a baseline Charlson–Deyo comorbidity index. If patients did not have a hospitalization record at their diagnosis date, baseline comorbidity was determined by looking back 2 years into the hospitalization data to find the most recent hospitalization record; the comorbidity score from that hospitalization was then applied . The Charlson–Deyo comorbidity index at baseline was marked as “missing” if the individual had no hospitalization records at diagnosis or during the 2 years before diagnosis.…”

Section: Methodsmentioning

confidence: 99%

“…Full details of data sources and estimation of direct health care costs associated with HCC has been previously published . The total costs of healthcare services included outpatient visits, emergency department visits, acute inpatient hospitalizations, same‐day surgery, prescription medications, homecare visits, continuing care, and long‐term care.…”

Section: Methodsmentioning

confidence: 99%

“…HCC is associated with high costs for treatment, in particular, SR and LT, and management of the cancer presents both clinical and financial challenges . Facilities and resources in Canada to deal with end‐stage liver disease are generally inadequate aside from the few pockets of expertise at university‐based centers that have limited capacity .…”

Section: Introductionmentioning

confidence: 99%

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Cost‐effectiveness analysis of potentially curative and combination treatments for hepatocellular carcinoma with person‐level data in a Canadian setting

et al. 2017

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Patients with early‐stage hepatocellular carcinoma (HCC) are potential candidates for curative treatments such as radiofrequency ablation (RFA), surgical resection (SR), or liver transplantation (LT), which have demonstrated a significant survival benefit. We aimed to estimate the cost‐effectiveness of curative and combination treatment strategies among patients diagnosed with HCC during 2002–2010. This study used Ontario Cancer Registry‐linked administrative data to estimate effectiveness and costs (2013 USD) of the treatment strategies from the healthcare payer's perspective. Multiple imputation by logistic regression was used to handle missing data. A net benefit regression approach of baseline important covariates and propensity score adjustment were used to calculate incremental net benefit to generate incremental cost‐effectiveness ratio (ICER) and uncertainty measures. Among 2,222 patients diagnosed with HCC, 10.5%, 14.1%, and 10.3% received RFA, SR, and LT monotherapy, respectively; 0.5–3.1% dual treatments; and 0.5% triple treatments. Compared with no treatment (53.2%), transarterial chemoembolization (TACE) + RFA (average $2,465, 95% CI: −$20,000–$36,600/quality‐adjusted life years [QALY]) or RFA monotherapy ($15,553, 95% CI: $3,500–$28,500/QALY) appears to be the most cost‐effective modality with lowest ICER value. The cost‐effectiveness acceptability curve showed that if the relevant threshold was $50,000/QALY, RFA monotherapy and TACE+ RFA would have a cost‐effectiveness probability of 100%. Strategies using LT delivered the most additional QALYs and became cost‐effective at a threshold of $77,000/QALY. Our findings found that TACE+ RFA dual treatment or RFA monotherapy appears to be the most cost‐effective curative treatment for patients with potential early stage of HCC in Ontario. These findings highlight the importance of identifying and measuring differential benefits, costs, and cost‐effectiveness of alternative HCC curative treatments in order to evaluate whether they are providing good value for money in the real world.

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Determinants of Healthcare Utilization Among Veterans with Inflammatory Bowel Disease

2016

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Trends in Health Care Utilization and Costs Attributable to Hepatocellular Carcinoma, 2002–2009: A Population-Based Cohort Study

Abstract: BackgroundThe incidence of hepatocellular carcinoma (hcc) and the complexity of its diagnosis and treatment

Cited by 9 publications

References 41 publications

Cost-effectiveness analysis of treatment with non-curative or palliative intent for hepatocellular carcinoma in the real-world setting

Cost-effectiveness analysis of treatment with non-curative or palliative intent for hepatocellular carcinoma in the real-world setting

Cost‐effectiveness analysis of potentially curative and combination treatments for hepatocellular carcinoma with person‐level data in a Canadian setting

Determinants of Healthcare Utilization Among Veterans with Inflammatory Bowel Disease

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