Skip to main content
Log in

The lifetime cost of hepatocellular carcinoma

A claims data analysis from a medical centre in Taiwan

  • Original Research Article
  • Published:
Applied Health Economics and Health Policy Aims and scope Submit manuscript

Abstract

Background

Hepatocellular carcinoma (HCC) is the second most common cancer in Taiwan. For males in Taiwan, it is the most dangerous cancer, with both the highest incidence and mortality rate.

Objective

To determine cancer-related medical care costs for long-term survivors of HCC.

Methods

The estimation of the lifetime cost was based on the insurer perspective and adopted an incidence-based approach. Data was sourced from the 1999–2002 cancer registry statistics of patients with HCC and the claims data of Taipei Veterans General Hospital (TVGH). In total there were 2873 HCC patients at TVGH. In addition to this data, the research used population National Health Insurance claims data from the National Health Research Institutes (1996–2002) as the comparison group. The probabilities of survival, dying of cancer or dying of other causes were estimated using cancer registry statistics. To estimate lifetime (10-year) cost, we divided the disease process into three phases: initial, continuing and terminal. The cost of HCC was calculated as the sum of the average cost of each phase. The expected lifetime cost for treatment of an HCC patient was estimated by incorporating the phase-specific costs with the survival and mortality rates.

Results

The results showed that 895 patients survived <1 year, and treatment for each of these patients cost on average New Taiwan dollars ($NT) 206 573 ($US1 = $NT33, year 2002 value) over this period. For those who survived ≥1 year, the terminal phase of treatment resulted in the highest costs, $NT237 032. On average, for each patient, the initial phase cost was $NT140 403 and the monthly cost for the continuing phase was $NT8687. For the average HCC patient, the 10-year lifetime cost was $NT418 554 (in nominal $NT).

Conclusion

Our study showed that the terminal phase cost the most out of the three treatment phases. The aggregate lifetime cost of HCC is useful for health policy making and clinical decision making.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Table I
Table II
Table III
Table IV
Fig. 3

Similar content being viewed by others

References

  1. Wang CP. The relationship between cancer incidence and cancer mortality in Taiwan [thesis]. Taichung: China Medical University, 2003

    Google Scholar 

  2. Department of Health, the Executive Yuan. Cancer registry annual report in Taiwan Area, 2001. Taipei: Department of Health, the Executive Yuan, 2004

    Google Scholar 

  3. Lee CL, Ko YC, Choong CS. Survival rate for liver cancer in Taiwan. Zhonghua Yi Xue Za Zhi 2000 Jan; 63(1): 16–20

    PubMed  CAS  Google Scholar 

  4. Lee CL, Ko YC. Survival and distribution pattern of childhood liver cancer in Taiwan. Eur J Cancer 1998 Dec; 34(13): 2064–7

    Article  PubMed  CAS  Google Scholar 

  5. Chen CJ, You SL, Lin LH, et al. Cancer epidemiology and control in Taiwan: a brief review. Jpn J Clin Oncol 2002 Mar; 32 Suppl.: S66–81

    Google Scholar 

  6. Chang MH, Chen CJ, Lai MS, et al. Universal hepatitis B vaccination in Taiwan and the incidence of hepatocellular carcinoma in children. Taiwan Childhood Hepatoma Study Group. N Engl J Med 1997 Jun 26; 336(26): 1855–9

    Article  PubMed  CAS  Google Scholar 

  7. Ni YH, Chang MH, Huang LM, et al. Hepatitis B virus infection in children and adolescents in a hyperendemic area: 15 years after mass hepatitis B vaccination. Ann Intern Med 2001; 135: 796–800

    PubMed  CAS  Google Scholar 

  8. Kao JH, Chen DS. Global control of hepatitis B virus. Lancet Infect Dis 2002; 2: 395–403

    Article  PubMed  Google Scholar 

  9. Kao JH, Chen DS. Changing disease burden of hepatocellular carcinoma in the Far East and Southeast Asia. Liver Int 2005; 25: 696–703

    Article  PubMed  Google Scholar 

  10. Drummond MF, O’Brien B, Stoddart GL, et al. Methods for the economic evaluation of health care programmes. 2nd ed. Oxford: Oxford Medical Publications, 1997

    Google Scholar 

  11. Brown ML, Riley GF, Schussler N, et al. Estimating health care costs related to cancer treatment from SEER-Medicare data. Med Care 2002 Aug; 40(8 Suppl.): 104–17

    Google Scholar 

  12. Baker MS, Kessler LG, Urban N, et al. Estimating the treatment costs of breast and lung cancer. Med Care 1991 Jan; 29(1): 40–9

    Article  PubMed  CAS  Google Scholar 

  13. Will BP, Berthelot J-M, LePetit C, et al. Estimates of the lifetime costs of breast cancer treatment in Canada. Eur J Cancer 2000 Apr; 36(6): 724–35

    Article  PubMed  CAS  Google Scholar 

  14. Riley GF, Potosky AL, Lubitz JD, et al. Medicare payments from diagnosis to death for elderly cancer patients by stage at diagnosis. Med Care 1995 Aug; 33(8): 828–41

    Article  PubMed  CAS  Google Scholar 

  15. Taplin SH, Barlow W, Urban N, et al. Stage, age, comorbidity, and direct costs of colon, prostate, and breast cancer care. J Natl Cancer Inst 1995 Mar; 87(6): 417–26

    Article  PubMed  CAS  Google Scholar 

  16. Hogan C, Lunney J, Gabel J, et al. Medicare beneficiaries–costs of care in the last year of life. Health Affairs 2001 Jul–Aug; 20(4): 188–95

    Article  PubMed  CAS  Google Scholar 

  17. Lubitz JD, Riley GF. Trends in Medicare payments in the last year of life. N Engl J Med 1993 Apr 15; 328(15): 1092–6

    Article  PubMed  CAS  Google Scholar 

  18. Kutikova L, Bowman L, Chang S, et al. The economic burden of lung cancer and the associated costs of treatment failure in the United States. Lung Cancer 2005 Nov; 50(2): 143–54

    Article  PubMed  Google Scholar 

  19. Riley GF, Potosky AL. Stage at diagnosis and treatment patterns among older women with breast cancer: an HMO and fee-for-service comparison. JAMA 1999 Feb 24; 281(8): 720–6

    Article  PubMed  CAS  Google Scholar 

  20. Riley GF, Potosky AL. Stage of cancer at diagnosis for Medicare HMO and fee-for-service enrollees. Am J Public Health 1994 Oct; 84(10): 1598–604

    Article  PubMed  CAS  Google Scholar 

  21. Etzioni R, Urban N, Baker M. Estimating the costs attributable to a disease with application to ovarian cancer. J Clin Epidemiol 1996 Jan; 49(1): 95–103

    Article  PubMed  CAS  Google Scholar 

  22. Potosky AL, Riley GF, Lubitz JD, et al. Potential for cancer related health services research using a linked Medicare-tumor registry database. Med Care 1993 Aug; 31(8): 732–48

    Article  PubMed  CAS  Google Scholar 

  23. Ramsey SD, Berry K, Etzioni R. Lifetime cancer-attributable cost of care for long term survivors of colorectal cancer. Am J Gastroenterol 2002 Feb; 97(2): 440–5

    Article  PubMed  Google Scholar 

  24. Brown ML, Riley GF, Potosky AL. Obtaining long-term disease specific costs of care: application to Medicare enrollees diagnosed with colorectal cancer. Med Care 1999 Dec; 37(12): 1249–59

    Article  PubMed  CAS  Google Scholar 

  25. Sullivan SD, Veenstra DL, Chen PJ, et al. Cost-effectiveness of peginterferon alfa-2a compared to lamivudine treatment in patients with hepatitis B e antigen positive chronic hepatitis B in Taiwan. J Gastroenterol Hepatol 2007 Sep; 22(9): 1494–9

    Article  PubMed  Google Scholar 

  26. Veenstra DL, Sullivan SD, Clarke L, et al. Cost effectiveness of entecavir versus lamivudine with adefovir salvage in HBeAg-positive chronic hepatitis B. Pharmacoeconomics 2007; 25(11): 963–77

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

This study was funded by Taiwan National Health Research Institutes (NHRI-EX94-9007PC). The authors would like to thank Wei-Lun Chen, Wei-Yi Huang, Yi-Lin Ko, Cheng-Yun Pu for the data management and SAS (SAS Institute Inc., Cary, NY, USA) programming.

The authors have no conflicts of interest that are directly relevant to the content of this study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Hui-Chu Lang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lang, HC., Wu, JC., Yen, SH. et al. The lifetime cost of hepatocellular carcinoma. Appl Health Econ Health Policy 6, 55–65 (2008). https://doi.org/10.2165/00148365-200806010-00005

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00148365-200806010-00005

Keywords

Navigation