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High Economic Burden of HCC Treated With Loco-Regional Therapies

January 27, 2021


Brian Seal, PhD, RPh, MBA, Senior Director HEOR, AstraZeneca, discusses results from a study which examined the lines of loco-regional therapies received by patients with hepatocellular carcinoma (HCC) in the US and the economic burden associated with the disease.

These results were presented at the virtual 2021 ASCO Gastrointestinal Cancers Symposium.


Hi, this is Brian Seal, Senior Director of Health Economics and Outcomes Research at AstraZeneca, background in clinical pharmacy as well as health outcomes. What I'm talking today is about a study that we did on the lines of local‑regional therapy received and the healthcare economic burden of newly diagnosed hepatocellular carcinoma in the United States.

One of the main things we wanted to look at, there's a lot of studies that go from diagnosis all the way through a systematic treatment to death, but we didn't really have that much out there in the literature around the cost of local regional therapy.

What we wanted to do was take a look at the time from diagnosis through the local‑regional therapy and then censor patients when they received systemic therapy so we could look at specifically that cost of local‑regional therapy.

The dataset that we chose is the IBM MarketScan dataset. One of the main reasons why we chose this dataset is patients can stay in a longer period of time because instead of your insurance, it's your employer. If you change insurance or if you go from commercial carrier to Medicare, you stay in the set. We're able to follow the patient over a longer period of time.

With this set, we looked at the ICD‑9 codes and ICD‑10 codes for HCC. Then, we looked at codes for ablative therapy, embolization therapy, TACE, TARE procedures, and radiation therapy. We want to look at these specific procedures done prior to systemic therapy.

When they receive systemic therapy, as I had said, we censored them at that point. We collected the economic information so all the resource utilization at this time. Then, we wanted to look at all costs for HCC‑related.

The time period this ran from was January 2016 through May 2018. We had to have at least 6 months previous and at least 1‑month follow‑up. We did allow for censoring related to patient sign. We looked at the number of embolization therapy, radiation therapy, ablative therapy, and those that got multiple local‑regional therapies as well.

We looked at all costs versus HCC‑related. What we found in the study population was that a large number of the population received this local therapy. Embolization therapy was almost 80%. 77% of the population received embolization, 28% received radiation, ablative therapy at about 28%, and those that received multiple therapies were 30%.

Now they could have received more than 1 of that, but of these costs related to the total cost in HCC‑related, HC‑ related costs ran about $23,000 as opposed to the total cost at 26. You can see that the majority of the cost was related to the local‑regional therapy, both on the outpatient medical services and inpatient services.

The outpatient services were about $10,000, and the inpatient services is $4,000 or ran between $14,000 to $23,000 for this population. Overall, the key was to understand some of the costs incurred by the plans for this TACE and TAREs and these other ablative therapies and radiation therapy prior to getting the systemic therapy.

It allows us to try to understand how this patient population uses the resources utilization as well as the plans to understand the resource utilization and understand where their costs are coming from and what his HCC population looks like.   

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