Healthcare Costs Related to Treatment of Hepatocellular Carcinoma Among Veterans With Cirrhosis in the United States.

It is important to quantify medical costs associated with hepatocellular carcinoma (HCC), the incidence of which is rapidly increasing incidence in the United States, for development of rational healthcare policies related to liver cancer surveillance and treatment of chronic liver disease. We aimed to comprehensively quantify healthcare costs for HCC among patients with cirrhosis in an integrated health system and develop a model for predicting costs based on clinically relevant variables.Three years subsequent to liver cancer diagnosis, costs accrued by patients included in the Veteran's Outcome and Cost Associated with Liver disease cohort were compiled using the Department of Veterans Affairs Corporate Data Warehouse. The cohort includes all patients with HCC diagnosed in calendar years 2008-2010 within the VA with 100% chart confirmation as well as chart abstraction of tumor and clinical characteristics. Cancer cases were matched 1:4 with non-cancer cirrhosis controls based on severity of liver disease, age, and comorbidities to estimate background cirrhosis-related costs. Univariable and multivariable generalized linear models were developed and used to predict cancer-related overall cost, survival and cost per life year.Our analysis included 3188 cases of HCC and 12,722 controls. The mean 3-year total cost of care in HCC patients was $154,688 (standard error, $150,953-$158,422) compared to $69,010 (standard error, $67,344-$70,675) in matched cirrhotic controls, yielding an incremental cost of $85,679; 64.9% of this value reflected increased inpatient costs. In univariable analyses, receipt of transplantation, Barcelona Clinic Liver Cancer stage, liver disease etiology, hospital academic affiliation, use of Multidisciplinary Tumor Board, and identification through surveillance were associated with cancer-related costs. Multivariable Generalized Linear Models incorporating transplantation status, BCLC stage and Multidisciplinary Tumor Board presentation accurately predicted liver cancer-related costs (Hosmer-Lemeshow goodness-of-fit P value ≅ 1.0).In a model developed to comprehensively quantify healthcare costs for HCC among patients with cirrhosis in an integrated health system, we associated receipt of liver transplantation, BCLC stage, and Multidisciplinary Tumor Board with higher costs but increased survival time. Models that predict total costs based on receipt of liver transplantation were constructed and can be used to model cost-effectiveness of therapies focused on HCC prevention.