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Published on: September 30, 2021
The cost of palliative care for hepatocellular carcinoma in Hong Kong
1Department of Clinical Oncology, Sir YK Pao Cancer Centre, Chinese University of Hong Kong, Prince of Wales Hospital. anthonytcchan@cuhk.edu.hk
Insights
Palliative care costs for Hepatocellular carcinoma (HCC) patients are influenced by survival, liver cirrhosis severity, and chemotherapy use. Understanding these factors helps model healthcare expenses for this cancer.
Area of Science:
- Oncology
- Health Economics
Background:
- Hepatocellular carcinoma (HCC) is a prevalent cancer in Asia and Africa, often diagnosed at stages unsuitable for curative treatment.
- Limited data exists on the economic burden of palliative care for HCC patients.
Purpose of the Study:
- To quantify patient-specific costs associated with palliative care for HCC.
- To identify individual factors influencing these costs and develop a predictive cost model.
Main Methods:
- Prospective tracking of 204 inoperable HCC patients from hospitalization to death.
- Societal cost perspective including formal and informal care services.
- Regression analysis to determine cost drivers using formal healthcare costs.
Main Results:
- Mean formal healthcare cost was HK$30,983 (US$3872) per patient.
- Factors increasing cost per day: higher Child-Pugh grade (liver cirrhosis severity).
- Factors decreasing cost per day: older age, longer observation, and survival.
- Nonsurvivorship, increased severity, and chemotherapy significantly increase overall costs.
Conclusions:
- The modest average cost per HCC patient in Hong Kong is linked to short median survival.
- Limited inpatient care and chemotherapy use contribute to lower overall costs.
- Cost drivers like severity and treatment influence economic burden.
Background:
Hepatocellular carcinoma (HCC) is endemic in parts of Asia and Africa and most patients are not suitable for treatment with a curative approach. Little is known about the cost of palliative care for HCC.
Objective:
To determine: (i) patient-specific costs of palliative care of HCC; and (ii) individual factors that drive patient-specific costs and to develop a model of cost per case under alternative circumstances.
Methods:
204 patients with inoperable HCC were prospectively tracked from first hospitalisation until death for health service utilisation. A societal perspective of cost was taken, including costs of formal and informal services incurred by payers, caregivers and patients. Observational data from a large Hong Kong cancer care programme were used. A regression analysis was performed using formal costs only, with the cost per observed day as the dependent variable.
Results:
The median survival was 95 days and the mean observation period was 153 days. The mean value per person for formal healthcare cost was 30 983 Hong Kong dollars [$HK] ($US3872, 1998 values). The distribution of cost values were positively skewed. The regression analysis showed that age, days of observation and survival were negatively related to cost per observed day, and the Child-Pugh grading of severity of liver cirrhosis was positively related to cost per observed day. A sensitivity analysis based on the regression equation indicated that nonsurvivorship doubles the cost per case, increased severity as measured by the Child-Pugh Index adds about 50% to the cost, and chemotherapy increases cost 2-fold.
Conclusions:
The relatively modest average cost per patient with HCC in Hong Kong reflects the short median survival and subsequently the limited use of inpatient care and chemotherapy.