title: Direct costs of care for hepatocellular carcinoma in patients with hepatitis C cirrhosis.
abstract: BACKGROUND
  Hepatitis C virus (HCV) is the commonest cause of hepatocellular carcinoma (HCC) in the United States. The benefits of HCV therapy may be measured in part by the prevention of HCC and other complications of cirrhosis. The true cost of care of the HCV patient with HCC is unknown.
  
  
  METHODS
  One hundred patients were randomly selected from a cohort of all HCC patients with HCV at a US transplant center between 2003 and 2013. Patients were categorized by the primary treatment modality, Barcelona class, and ultimate transplant status. Costs included the unit costs of procedures, imaging, hospitalizations, medications, and all subsequent care of the HCC patient until either death or the end of follow-up. Associations with survival and cost were assessed in multivariate regression models.
  
  
  RESULTS
  Overall costs included a median of $176,456 (interquartile range [IQR], $84,489-$292,192) per patient or $6279 (IQR, $4043-$9720) per patient-month of observation. The median costs per patient-month were $7492 (IQR, $5137-$11,057) for transplant patients and $4830 for nontransplant patients. The highest median monthly costs were for transplant patients with Barcelona A4 disease ($11,349) and patients who received chemoembolization whether they underwent transplantation ($10,244) or not ($8853). Transarterial chemoembolization and radiofrequency ablation were independently associated with a 28% increase and a 22% decrease in costs, respectively, with adjustments for the severity of liver disease and Barcelona class.
  
  
  CONCLUSIONS
  These data represent real-world estimates of the cost of HCC care provided at a transplant center and should inform economic studies of HCV therapy.
authors.affiliation: Division of Gastroenterology/Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Elliot B
authors.initials: EB
authors.lastname: Tapper
authors.affiliation: Division of Gastroenterology/Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Andreea M
authors.initials: AM
authors.lastname: Catana
authors.affiliation: Division of Gastroenterology/Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Nidhi
authors.initials: N
authors.lastname: Sethi
authors.affiliation: Division of Gastroenterology/Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Daniel
authors.initials: D
authors.lastname: Mansuri
authors.affiliation: Division of Gastroenterology/Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Sethi
authors.affiliation: Division of Gastroenterology/Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Annie
authors.initials: A
authors.lastname: Vong
authors.affiliation: Division of Gastroenterology/Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Nezam H
authors.initials: NH
authors.lastname: Afdhal
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000191:economics* / Q000473:pathology / Q000601:surgery* / Q000628:therapy / Q000821:virology; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000821:virology*; D008113:Liver Neoplasms / Q000191:economics* / Q000473:pathology / Q000601:surgery* / Q000628:therapy / Q000821:virology; D016031:Liver Transplantation / Q000191:economics*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D014481:United States
keywords: liver cancer; liver disease; liver transplant; tumor; viral hepatitis