Treatment patterns and medical costs after hepatectomy in real‐world practice for patients with hepatocellular carcinoma in Japan

• Published in: Hepatology research 2021-10, Vol.51 (10), p.1073-1081
• Main Authors: Terashima, Takeshi, Higashibeppu, Yoichi, Yamashita, Tatsuya, Sakata, Yukinori, Azuma, Mie, Fujimoto, Kenichi, Munakata, Hiroaki, Ishii, Mika, Kaneko, Shuichi
• Format: Article
• Language: English
• Subjects: Antineoplastic drugs; Antiviral agents; antiviral therapy; Costs; economic burden; Hepatectomy; Hepatitis; Hepatitis C; Hepatocellular carcinoma; Japan; Liver cancer; medical costs; Patients
• ISSN: 1386-6346; 1872-034X
• DOI: 10.1111/hepr.13701

Aim To examine the treatment patterns and medical costs in real‐world practice among patients who received hepatectomy for hepatocellular carcinoma (HCC) in Japan. Methods Data of patients who underwent hepatectomy as an initial therapy for primary HCC were extracted from a Japanese medical claims database from April 2008 to December 2019. The types of additional treatments for recurrent HCC and medical costs for up to 3 years from the first hepatectomy were analyzed. The average cumulative cost per patient starting on the date of the first hepatectomy was calculated using the Kaplan‐Meier sample‐average method. Results Data from 2 342 patients (median age, 71 years) were analyzed. Overall, 35.6% of patients received at least one HCC treatment within 3 years of the first hepatectomy. The total average cumulative 3‐years medical cost was JPY 4 993 300 (95% confidence interval [CI]: 4 804 100 to 5 220 500). Surgical procedures were the most costly components in the first month after hepatectomy, whereas the costs of drugs, which mainly included antiviral and antineoplastic medications, increased thereafter. Patients with advanced stage HCC, hepatitis C, or a higher Charlson Comorbidity Index at hepatectomy, or those who required additional treatment, especially with antineoplastic drugs for recurrent HCC, incurred higher medical costs. Conclusions Patients with HCC after hepatectomy experienced a large economic burden, which was more serious for those with advanced stage HCC, higher comorbidities, and hepatitis at baseline and for patients treated with antineoplastic drugs. A treatment selection that considers its medical cost burden would help to reduce some of these economic burdens.