Treatment and Cost of Hepatocellular Carcinoma: A Population-Based Cohort Study in Taiwan

Seng-Howe Nguang, Cheng-Kun Wu, Chih-Ming Liang, Wei-Chen Tai, Shih-Cheng Yang, Ming-Kun Ku, Lan-Ting Yuan, Jiunn-Wei Wang, Kuo-Lun Tseng, Tsung-Hsing Hung, Pin-I Hsu, Deng-Chyang Wu, Seng-Kee Chuah and Chien-Ning Hsu
Additional contact information
Seng-Howe Nguang: Division of Gastroenterology, Pin-Tung Christian Hospital, Pin-Tung 900, Taiwan
Cheng-Kun Wu: Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
Chih-Ming Liang: Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
Wei-Chen Tai: Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
Shih-Cheng Yang: Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
Ming-Kun Ku: Division of Gastroenterology, Fu-Ying University Hospital, Kaohsiung 831, Taiwan
Lan-Ting Yuan: Division of Gastroenterology, Yuan’s General Hospital, Kaohsiung 802, Taiwan
Jiunn-Wei Wang: Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung 807, Taiwan
Kuo-Lun Tseng: Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung 807, Taiwan
Tsung-Hsing Hung: Division of Hepatogastroenterology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Dalin Branch, Chia-Yi 622, Taiwan
Pin-I Hsu: Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, National Yang-Ming University, Kaohsiung 813, Taiwan
Deng-Chyang Wu: Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung 807, Taiwan
Seng-Kee Chuah: Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
Chien-Ning Hsu: Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan

IJERPH, 2018, vol. 15, issue 12, 1-12

Abstract: 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.

Keywords: hepatocellular carcinoma; epidemiology; liver; cost; disease burden; healthcare; Taiwan (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2018
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