Applied Health Economics and Health Policy

, Volume 6, Issue 1, pp 55–65

The lifetime cost of hepatocellular carcinoma

A claims data analysis from a medical centre in Taiwan
  • Hui-Chu Lang
  • Jaw-Ching Wu
  • Sang-Hue Yen
  • Chung-Fu Lan
  • Shi-Liang Wu
Original Research Article

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.

References

  1. 1.
    Wang CP. The relationship between cancer incidence and cancer mortality in Taiwan [thesis]. Taichung: China Medical University, 2003Google Scholar
  2. 2.
    Department of Health, the Executive Yuan. Cancer registry annual report in Taiwan Area, 2001. Taipei: Department of Health, the Executive Yuan, 2004Google Scholar
  3. 3.
    Lee CL, Ko YC, Choong CS. Survival rate for liver cancer in Taiwan. Zhonghua Yi Xue Za Zhi 2000 Jan; 63(1): 16–20PubMedGoogle Scholar
  4. 4.
    Lee CL, Ko YC. Survival and distribution pattern of childhood liver cancer in Taiwan. Eur J Cancer 1998 Dec; 34(13): 2064–7PubMedCrossRefGoogle Scholar
  5. 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.: S66–81Google Scholar
  6. 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): 1855–9PubMedCrossRefGoogle Scholar
  7. 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: 796–800PubMedGoogle Scholar
  8. 8.
    Kao JH, Chen DS. Global control of hepatitis B virus. Lancet Infect Dis 2002; 2: 395–403PubMedCrossRefGoogle Scholar
  9. 9.
    Kao JH, Chen DS. Changing disease burden of hepatocellular carcinoma in the Far East and Southeast Asia. Liver Int 2005; 25: 696–703PubMedCrossRefGoogle Scholar
  10. 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, 1997Google Scholar
  11. 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.): 104–17Google Scholar
  12. 12.
    Baker MS, Kessler LG, Urban N, et al. Estimating the treatment costs of breast and lung cancer. Med Care 1991 Jan; 29(1): 40–9PubMedCrossRefGoogle Scholar
  13. 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): 724–35PubMedCrossRefGoogle Scholar
  14. 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): 828–41PubMedCrossRefGoogle Scholar
  15. 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): 417–26PubMedCrossRefGoogle Scholar
  16. 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): 188–95PubMedCrossRefGoogle Scholar
  17. 17.
    Lubitz JD, Riley GF. Trends in Medicare payments in the last year of life. N Engl J Med 1993 Apr 15; 328(15): 1092–6PubMedCrossRefGoogle Scholar
  18. 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): 143–54PubMedCrossRefGoogle Scholar
  19. 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): 720–6PubMedCrossRefGoogle Scholar
  20. 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): 1598–604PubMedCrossRefGoogle Scholar
  21. 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): 95–103PubMedCrossRefGoogle Scholar
  22. 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): 732–48PubMedCrossRefGoogle Scholar
  23. 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): 440–5PubMedCrossRefGoogle Scholar
  24. 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): 1249–59PubMedCrossRefGoogle Scholar
  25. 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): 1494–9PubMedCrossRefGoogle Scholar
  26. 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): 963–77PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2008

Authors and Affiliations

  • Hui-Chu Lang
    • 1
  • Jaw-Ching Wu
    • 2
    • 3
  • Sang-Hue Yen
    • 4
  • Chung-Fu Lan
    • 5
  • Shi-Liang Wu
    • 6
  1. 1.Institute of Hospital and Health Care AdministrationNational Yang-Ming University, TaiwanTaipeiTaiwan
  2. 2.School of Medicine, Institute of Clinical MedicineNational Yang-Ming UniversityTaipeiTaiwan
  3. 3.Department of Medical Research and EducationTaipei Veterans General HospitalTaipeiTaiwan
  4. 4.Cancer CenterTaipei Veterans General HospitalTaipeiTaiwan
  5. 5.School of Medicine, Institute of Health and Welfare PolicyNational Yang-Ming UniversityTaipeiTaiwan
  6. 6.Population and Health Research CenterBureau of Health Promotion, Department of HealthTaichungTaiwan

Personalised recommendations