title: Trends in health care utilization and costs attributable to hepatocellular carcinoma, 2002-2009: a population-based cohort study.
abstract: BACKGROUND
  The incidence of hepatocellular carcinoma (hcc) and the complexity of its diagnosis and treatment are increasing. We estimated trends in net health care utilization, costs of care attributable to hcc in Ontario, and rate ratios of resource use at various stages of care.
  
  
  METHODS
  This population-based retrospective cohort study identified hcc patients and non-cancer control subjects, and health care resource utilization between 2002 and 2009. Generalized estimating equations were then used to estimate net health care utilization (hcc patients vs. the matched control subjects) and net costs of care attributable to hcc. Generalized linear models were used to analyze rate ratios of resource use.
  
  
  RESULTS
  We identified 2832 hcc patients and 2808 matched control subjects. In comparison with the control subjects, hcc patients generally used a greater number of health care services. Overall, the mean net cost of care per 30 patient-days (2013 Canadian dollars) attributable to outpatient visits and hospitalizations was highest in the pre-diagnosis (1 year before diagnosis), initial (1st year after diagnosis), and end-of-life (last 6 months before death, short-term survivors) phases. Mean net homecare costs were highest in the end-of-life phase (long-term survivors). In the end-of-life phase (short-term survivors), mean net costs attributable to outpatient visits and total services significantly increased to $14,220 from $1,547 and to $33,121 from $14,450 (2008-2009 and 2002-2003 respectively).
  
  
  CONCLUSIONS
  In hcc, our study found increasing resource use and net costs of care, particularly in the end-of-life phase among short-term survivors. Our findings offer a basis for resource allocation decisions in the area of cancer prevention and control.
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, ON;; Ontario Institute for Cancer Research, Toronto, ON;; Institute for Clinical Evaluative Sciences, Toronto, ON;
authors.forename: H H
authors.initials: HH
authors.lastname: Thein
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, ON;
authors.forename: Y
authors.initials: Y
authors.lastname: Qiao
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, ON;
authors.forename: S K
authors.initials: SK
authors.lastname: Young
authors.affiliation: Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON;
authors.forename: W
authors.initials: W
authors.lastname: Zarin
authors.affiliation: University of British Columbia, Division of Gastroenterology, Vancouver, BC;
authors.forename: E M
authors.initials: EM
authors.lastname: Yoshida
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, ON;; Centre for Addiction and Mental Health, Toronto, ON;; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON;
authors.forename: C
authors.initials: C
authors.lastname: de Oliveira
authors.affiliation: Ontario Institute for Cancer Research, Toronto, ON;; Institute for Clinical Evaluative Sciences, Toronto, ON;; Cancer Care Ontario, Toronto, ON.
authors.forename: C C
authors.initials: CC
authors.lastname: Earle
keywords: Costs; cost analyses; economics; end-of-life care; health care utilization; liver cancer; survivors