Treatment patterns and costs of care for patients diagnosed with hepatocellular carcinoma (HCC) in the United States (U.S.)

Abstract

Methods: 12 patients (8 men, 4 women) with a median age of 64.5 years [range 44-83] suffering from both liver cirrhosis B7-B9 and unresectable nonmetastatic HCC were treated once or twice with Y-90 resin microspheres in our hospital in the years 2013-2017. In most patients alcohol abuse was the cause of liver cirrhosis. TACE was considered not to be effective in these patients. Our exclusion criteria for selective internal radiotherapy (SIRT) were either serum bilirubin >2.4 mg%, infiltration of the portal vein by tumor, portal vein thrombosis, extrahepatic metastasis, significant ascites, renal insufficiency, concurrent infection, uncontrolled bleeding or significant encephalopathy. Patients with bilobar HCC were scheduled for 2 separate unilobar SIRT sessions (1 right-sided, 1 left-sided, 4-6 weeks apart). Results: All patients adhered well to therapy and follow-up. Y-90 resin microspheres were well tolerated by the patients. In 2 patients transient flares of AST and/or ALT and/or bilirubin were noted. Epigastric discomfort for 1-2 days was reported by 5 patients. 10 patients died due to progressive disease, 2 patients are still alive. At 3 months after 1st SIRT the disease control rate was 50%. A median overall survival of 10.0 [range 4-16] months as calculated from 1st unilobar application of Y-90 microspheres was observed at this interim analysis; mean overall survival (after SIRT) amounts now to 9.3 þ 3.7 months (11.8 months for B7 and 7.5 months for B9 patients). Due to angiographic evaluation and ordering of Y-90 microspheres from overseas 4-6 weeks (without specific treatment) passed by between decision making and the first SIRT. Conclusion: SIRT therapy is safe in patients with unresectable nonmetastatic HCC and liver cirrhosis Child Pugh B7-9, as the chosen exclusion criteria are respected. Overall survival of our patients is better than the one reported for sorafenib treatment in HCCpatients with liver cirrhosis B7-9 of the GIDEON trial. Thus, SIRT with Y-90 resin microspheres should be considered for patients with unresectable nonmetastatic HCC and liver cirrhosis B7-9, if our exclusion criteria are observed. P À 098 Treatment patterns and costs of care for patients diagnosed with hepatocellular carcinoma (HCC) in the United States (U.S.

Epidemiologic, humanistic and economic burden of hepatocellular carcinoma in the USA: a systematic literature review

“…A total of seven studies reported mean per month direct medical costs [ 52 , 57 , 65 , 68 , 71 , 74 , 103 ]; two of these studies described only patients receiving systemic treatment [ 52 , 57 ] and one compared costs among patients with HCV and cirrhosis, HCC or transplant [ 103 ]. The remaining four studies described monthly costs among nonselected cohorts ( Supplementary Table 5 ) [ 65 , 68 , 71 , 74 ].…”

“…A total of 16 studies reported long-term direct medical costs [ 17 , 39 , 43 , 44 , 46 , 49 , 50 , 53 , 56 , 57 , 60 , 61 , 70 , 71 , 81 , 104 ]; three of these studies described charges [ 17 , 56 , 104 ], four described costs related to specific interventions [ 53 , 57 , 61 , 81 ] and five described costs among specific etiologies [ 39 , 43 , 44 , 46 , 49 ]. The remaining four studies described long-term costs among nonselected cohorts ( Supplementary Table 6 ) [ 50 , 60 , 70 , 71 ].…”

“…A total of 13 studies reported inpatient length of stay [ 17 , 41 , 50 , 57 , 59 , 63 , 66 , 67 , 75 , 76 , 99 , 100 , 102 ], of which four studies described nonselected cohorts and reported trends over time [ 59 , 66 ], by etiology [ 102 ], and by age or payer [ 50 ]. The typical inpatient length of stay was approximately 6 days.…”

Management of Adverse Events Associated with Cabozantinib Treatment in Patients with Advanced Hepatocellular Carcinoma

“…HCC emerges primarily in older adults [29]. In addition to the underlying HCC etiology, older adults with HCC are likely to have additional co-morbidities such as cardiovascular or pulmonary disease [30], and it is not uncommon for patients with HCC to have multiple co-morbidities [31]. Liver cirrhosis, with compromised liver function and decreased hepatic reserve, is a major risk factor for HCC development.…”

Locoregional therapy patterns and healthcare economic burden of patients with hepatocellular carcinoma in the USA

“…Although there are several studies in which the treatment patterns and/or healthcare costs of patients diagnosed with any stage or advanced stages of HCC have been evaluated in real-world settings [3,[9][10][11][12][13][14][15], there is limited information available regarding the real-world treatment patterns and healthcare economic burden specifically of patients diagnosed with locoregional disease, especially in USA. In the multi-national BRIDGE Study, Park et al reported that TACE, which was the most commonly used first-line therapy across patients with any stage HCC, was received by a third of patients in North America 2005-2012 (n = 2326; 37% had stage 0-A; 10% had stage B; 53% had stage C or D) [3].…”