The lifetime cost of hepatocellular carcinoma : a claims data analysis from a medical centre in Taiwan.
BACKGROUND
Hepatocellular carcinoma (HCC) is the second most common cancer in Taiwan. For males in Taiwan, it is the most dangerous cancer, with both the highest incidence and mortality rate.


OBJECTIVE
To determine cancer-related medical care costs for long-term survivors of HCC.


METHODS
The estimation of the lifetime cost was based on the insurer perspective and adopted an incidence-based approach. Data was sourced from the 1999-2002 cancer registry statistics of patients with HCC and the claims data of Taipei Veterans General Hospital (TVGH). In total there were 2873 HCC patients at TVGH. In addition to this data, the research used population National Health Insurance claims data from the National Health Research Institutes (1996-2002) as the comparison group. The probabilities of survival, dying of cancer or dying of other causes were estimated using cancer registry statistics. To estimate lifetime (10-year) cost, we divided the disease process into three phases: initial, continuing and terminal. The cost of HCC was calculated as the sum of the average cost of each phase. The expected lifetime cost for treatment of an HCC patient was estimated by incorporating the phase-specific costs with the survival and mortality rates.


RESULTS
The results showed that 895 patients survived <1 year, and treatment for each of these patients cost on average New Taiwan dollars ($NT) 206 573 ($US 1 = $NT 33, year 2002 value) over this period. For those who survived > or =1 year, the terminal phase of treatment resulted in the highest costs, $NT 237 032. On average, for each patient, the initial phase cost was $NT 140 403 and the monthly cost for the continuing phase was $NT 8687. For the average HCC patient, the 10-year lifetime cost was $NT 418 554 (in nominal $NT).


CONCLUSIONS
Our study showed that the terminal phase cost the most out of the three treatment phases. The aggregate lifetime cost of HCC is useful for health policy making and clinical decision making.
Lang
Hui-Chu
HC
Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan. hclang@ym.edu.tw
Wu
Jaw-Ching
JC
Yen
Sang-Hue
SH
Lan
Chung-Fu
CF
Wu
Shi-Liang
SL
D000368:Aged; D000465:Algorithms; D006528:Carcinoma, Hepatocellular / Q000191:economics*; D016022:Case-Control Studies; D005260:Female; D017048:Health Care Costs; D006787:Hospitals, Veterans; D006801:Humans; D008113:Liver Neoplasms / Q000191:economics*; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics*; D012042:Registries; D017741:Survivors; D013624:Taiwan; D013727:Terminal Care / Q000191:economics