Healthcare Costs for Medicare Patients With Hepatocellular Carcinoma in the United States

Hepatocellular carcinoma (HCC) has an increasing mortality in the United States and is a leading cause of morbidity and mortality in patients with cirrhosis. We aimed to estimate the financial burden related to HCC in a large nationally representative United States cohort. We used the Surveillance,...

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Veröffentlicht in:Clinical gastroenterology and hepatology 2023-08, Vol.21 (9), p.2327-2337.e9
Hauptverfasser: Karim, Mohammad A., Ramezani, Mahin, Leroux, Todd, Kum, Hye-Chung, Singal, Amit G.
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container_end_page 2337.e9
container_issue 9
container_start_page 2327
container_title Clinical gastroenterology and hepatology
container_volume 21
creator Karim, Mohammad A.
Ramezani, Mahin
Leroux, Todd
Kum, Hye-Chung
Singal, Amit G.
description Hepatocellular carcinoma (HCC) has an increasing mortality in the United States and is a leading cause of morbidity and mortality in patients with cirrhosis. We aimed to estimate the financial burden related to HCC in a large nationally representative United States cohort. We used the Surveillance, Epidemiology, and End Results program (SEER)-Medicare database to identify 4525 adult patients who were diagnosed with HCC between 2011 and 2015. We generated a 1:1 propensity score-matched cohort of patients with cirrhosis but no HCC as a comparator group to define incremental HCC-specific costs beyond costs related to underlying cirrhosis. Our main outcomes were patient liabilities and Medicare payments in the first year after HCC diagnosis. Compared with patients with cirrhosis, those with HCC had higher incremental patient liabilities (median +$7166; interquartile range, $2401–$16,099) and Medicare payments (+$50,110; interquartile range, $142,42–$136,239; P < .001 for both) in the first year after diagnosis. Patients with HCC had significantly higher inpatient, outpatient, and physician service costs compared with the matched cohort with cirrhosis (P < .001 for all). Patients with early-stage HCC had lower incremental patient liabilities (median, $4195 vs $8238; P < .001) and Medicare payments (median, $28,207 vs $59,509; P < .001) than those with larger tumor burden. In multivariable median regression analysis, incremental patient liabilities and Medicare payments were significantly associated with the National Cancer Institute comorbidity index, nonalcoholic fatty liver disease etiology, presence of ascites, and presence of hepatic encephalopathy. Patients with HCC suffer from cancer-related financial burden, highlighting a need for policy interventions and financial support systems.
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We aimed to estimate the financial burden related to HCC in a large nationally representative United States cohort. We used the Surveillance, Epidemiology, and End Results program (SEER)-Medicare database to identify 4525 adult patients who were diagnosed with HCC between 2011 and 2015. We generated a 1:1 propensity score-matched cohort of patients with cirrhosis but no HCC as a comparator group to define incremental HCC-specific costs beyond costs related to underlying cirrhosis. Our main outcomes were patient liabilities and Medicare payments in the first year after HCC diagnosis. Compared with patients with cirrhosis, those with HCC had higher incremental patient liabilities (median +$7166; interquartile range, $2401–$16,099) and Medicare payments (+$50,110; interquartile range, $142,42–$136,239; P &lt; .001 for both) in the first year after diagnosis. Patients with HCC had significantly higher inpatient, outpatient, and physician service costs compared with the matched cohort with cirrhosis (P &lt; .001 for all). Patients with early-stage HCC had lower incremental patient liabilities (median, $4195 vs $8238; P &lt; .001) and Medicare payments (median, $28,207 vs $59,509; P &lt; .001) than those with larger tumor burden. In multivariable median regression analysis, incremental patient liabilities and Medicare payments were significantly associated with the National Cancer Institute comorbidity index, nonalcoholic fatty liver disease etiology, presence of ascites, and presence of hepatic encephalopathy. Patients with HCC suffer from cancer-related financial burden, highlighting a need for policy interventions and financial support systems.</description><identifier>ISSN: 1542-3565</identifier><identifier>ISSN: 1542-7714</identifier><identifier>EISSN: 1542-7714</identifier><identifier>DOI: 10.1016/j.cgh.2022.11.015</identifier><identifier>PMID: 36435358</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Carcinoma, Hepatocellular - epidemiology ; Carcinoma, Hepatocellular - therapy ; Financial Burden ; Health Care Costs ; Healthcare Expenditure ; Hepatocellular Carcinoma ; Humans ; Liver Cancer ; Liver Cirrhosis - complications ; Liver Neoplasms - complications ; Liver Neoplasms - epidemiology ; Liver Neoplasms - therapy ; Medicare ; United States</subject><ispartof>Clinical gastroenterology and hepatology, 2023-08, Vol.21 (9), p.2327-2337.e9</ispartof><rights>2023 AGA Institute</rights><rights>Copyright © 2023 AGA Institute. 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Patients with HCC had significantly higher inpatient, outpatient, and physician service costs compared with the matched cohort with cirrhosis (P &lt; .001 for all). Patients with early-stage HCC had lower incremental patient liabilities (median, $4195 vs $8238; P &lt; .001) and Medicare payments (median, $28,207 vs $59,509; P &lt; .001) than those with larger tumor burden. In multivariable median regression analysis, incremental patient liabilities and Medicare payments were significantly associated with the National Cancer Institute comorbidity index, nonalcoholic fatty liver disease etiology, presence of ascites, and presence of hepatic encephalopathy. 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subjects Adult
Aged
Carcinoma, Hepatocellular - epidemiology
Carcinoma, Hepatocellular - therapy
Financial Burden
Health Care Costs
Healthcare Expenditure
Hepatocellular Carcinoma
Humans
Liver Cancer
Liver Cirrhosis - complications
Liver Neoplasms - complications
Liver Neoplasms - epidemiology
Liver Neoplasms - therapy
Medicare
United States
title Healthcare Costs for Medicare Patients With Hepatocellular Carcinoma in the United States
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