Hepatocellular Carcinoma Surveillance Among Cirrhotic Patients With Commercial Health Insurance.
OBJECTIVE
To evaluate hepatocellular carcinoma (HCC) surveillance rates among commercially insured patients, and evaluate factors associated with compliance with surveillance recommendations.


BACKGROUND
Most HCC occurs in patients with cirrhosis. American Association for the Study of Liver Diseases and European Association for the Study of the Liver guidelines each recommend biannual HCC surveillance for cirrhotic patients to diagnose HCC at an early, curable stage. However, compliance with these guidelines in commercially insured patients is unknown.


METHODS
We used the Truven Health Analytics databases from 2006 to 2010, using January 1, 2006 as the anchor date for evaluating outcomes. The primary outcome was continuous surveillance measure, defined as the proportion of time "up-to-date" with surveillance (PTUDS), with the 6-month interval immediately following each ultrasound categorized as "up-to-date."


RESULTS
During a median follow-up of 22.9 (interquartile range, 16.3 to 33.9) months among 8916 cirrhotic patients, the mean PTUDS was 0.34 (SD, 0.29), and the median was 0.31 (interquartile range, 0.03 to 0.52). These values increased only modestly with inclusion of serum alpha-fetoprotein testing, contrast-enhanced abdominal computed tomographic scans or magnetic resonance imagings, and/or extension of up-to-date time to 12 months. Being diagnosed by a nongastroenterology provider and increasing age were significantly associated with decreased HCC surveillance (P<0.05), whereas a history of a hepatic decompensation event, presence of any component of the metabolic syndrome, and diagnosis of hepatitis B or hepatitis C were significantly associated with increased surveillance (P<0.05). However, even among patients with the most favorable characteristics, surveillance rates remained low.


CONCLUSIONS
HCC surveillance rates in commercially insured at-risk patients remain poor despite formalized guidelines, highlighting the need to develop interventions to improve surveillance rates.
*Division of Gastroenterology, Hospital of the University of Pennsylvania †Center for Clinical Epidemiology and Biostatistics ‡Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA §Bayer HealthCare, Bayer HealthCare Pharmaceuticals, Wayne, NJ ∥Department of Pharmaceutical Health Outcomes and Policy, University of Houston, Houston, TX.
David S
DS
Goldberg
Adriana
A
Valderrama
Rajesh
R
Kamalakar
Sujit S
SS
Sansgiry
Svetlana
S
Babajanyan
James D
JD
Lewis
D000293:Adolescent; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000000981:diagnostic imaging* / Q000209:etiology; D016208:Databases, Factual; D055088:Early Detection of Cancer / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000097:blood / Q000000981:diagnostic imaging* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D011159:Population Surveillance / Q000379:methods; D017410:Practice Guidelines as Topic; D014481:United States; D057832:Watchful Waiting / Q000706:statistics & numerical data* / Q000639:trends; D055815:Young Adult; D000509:alpha-Fetoproteins / Q000378:metabolism
D000509:alpha-Fetoproteins