Healthcare costs related to adverse events in hepatocellular carcinoma treatment: A retrospective observational claims study
Background Hepatocellular carcinoma (HCC) is an aggressive form of liver cancer with increasing incidence and mortality worldwide. For metastatic disease, systemic treatment is recommended. In addition to tumor characteristics, adverse events (AEs) may influence regimen choice. Aim To analyze health...
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| Published in | Cancer reports Vol. 5; no. 5; pp. e1504 - n/a |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | English |
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United States
John Wiley & Sons, Inc
01.05.2022
John Wiley and Sons Inc Wiley |
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| Abstract | Background
Hepatocellular carcinoma (HCC) is an aggressive form of liver cancer with increasing incidence and mortality worldwide. For metastatic disease, systemic treatment is recommended. In addition to tumor characteristics, adverse events (AEs) may influence regimen choice.
Aim
To analyze healthcare burden among patients with advanced HCC, by treatment type and AEs observed.
Methods
Included were adult commercial and Medicare Advantage enrollees with ≥2 non‐diagnostic claims coded for HCC (the first setting the index date); ≥1 claim for systemic treatment of advanced/metastatic HCC; and continuous enrollment for a 6‐month pre‐index baseline period to ≥1 month post‐index (follow‐up). Patients were excluded by lack of systemic treatment; incomplete demographic information; pregnancy, liver transplant, other cancers during baseline or clinical trial participation. We describe patient characteristics, common AEs, overall survival, and healthcare burden in 2017 USD up to 12 months after initiation of tyrosine kinase inhibitor (TKI) monotherapy; immune checkpoint inhibitor (ICI) monotherapy; or FOLFOX combination therapy.
Results
The analytic sample consisted of 322 patients (median age 65.8 years, 76% male) who had 12 months' (unless death occurred prior) available follow‐up, with median follow‐up of 9 months. Among these, 241 (75%) had TKI monotherapy, 23 (7%) had ICI monotherapy, and 58 had FOLFOX (18%) first‐line treatment. Overall, patients had a high burden of AEs (mean 3.2), with the most prevalent being pain (75%), infection (39%), ascites (34%), and bleeding (29%). After adjusting for covariates, infection ($50 374), fever ($47 443), and diarrhea ($29 912) imposed the highest incremental annual costs versus patients without the AE. Up to 90% of costs were attributable to inpatient admissions, with 56% to 60% involving intensive care. Median 1‐year survival was 32%.
Conclusions
This real‐world study demonstrated AE burden in alignment with previous clinical studies. Regardless of regimen used, AEs are associated with substantial healthcare costs due to inpatient care. |
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| AbstractList | Abstract
Background
Hepatocellular carcinoma (HCC) is an aggressive form of liver cancer with increasing incidence and mortality worldwide. For metastatic disease, systemic treatment is recommended. In addition to tumor characteristics, adverse events (AEs) may influence regimen choice.
Aim
To analyze healthcare burden among patients with advanced HCC, by treatment type and AEs observed.
Methods
Included were adult commercial and Medicare Advantage enrollees with ≥2 non‐diagnostic claims coded for HCC (the first setting the index date); ≥1 claim for systemic treatment of advanced/metastatic HCC; and continuous enrollment for a 6‐month pre‐index baseline period to ≥1 month post‐index (follow‐up). Patients were excluded by lack of systemic treatment; incomplete demographic information; pregnancy, liver transplant, other cancers during baseline or clinical trial participation. We describe patient characteristics, common AEs, overall survival, and healthcare burden in 2017 USD up to 12 months after initiation of tyrosine kinase inhibitor (TKI) monotherapy; immune checkpoint inhibitor (ICI) monotherapy; or FOLFOX combination therapy.
Results
The analytic sample consisted of 322 patients (median age 65.8 years, 76% male) who had 12 months' (unless death occurred prior) available follow‐up, with median follow‐up of 9 months. Among these, 241 (75%) had TKI monotherapy, 23 (7%) had ICI monotherapy, and 58 had FOLFOX (18%) first‐line treatment. Overall, patients had a high burden of AEs (mean 3.2), with the most prevalent being pain (75%), infection (39%), ascites (34%), and bleeding (29%). After adjusting for covariates, infection ($50 374), fever ($47 443), and diarrhea ($29 912) imposed the highest incremental annual costs versus patients without the AE. Up to 90% of costs were attributable to inpatient admissions, with 56% to 60% involving intensive care. Median 1‐year survival was 32%.
Conclusions
This real‐world study demonstrated AE burden in alignment with previous clinical studies. Regardless of regimen used, AEs are associated with substantial healthcare costs due to inpatient care. Hepatocellular carcinoma (HCC) is an aggressive form of liver cancer with increasing incidence and mortality worldwide. For metastatic disease, systemic treatment is recommended. In addition to tumor characteristics, adverse events (AEs) may influence regimen choice. To analyze healthcare burden among patients with advanced HCC, by treatment type and AEs observed. Included were adult commercial and Medicare Advantage enrollees with ≥2 non-diagnostic claims coded for HCC (the first setting the index date); ≥1 claim for systemic treatment of advanced/metastatic HCC; and continuous enrollment for a 6-month pre-index baseline period to ≥1 month post-index (follow-up). Patients were excluded by lack of systemic treatment; incomplete demographic information; pregnancy, liver transplant, other cancers during baseline or clinical trial participation. We describe patient characteristics, common AEs, overall survival, and healthcare burden in 2017 USD up to 12 months after initiation of tyrosine kinase inhibitor (TKI) monotherapy; immune checkpoint inhibitor (ICI) monotherapy; or FOLFOX combination therapy. The analytic sample consisted of 322 patients (median age 65.8 years, 76% male) who had 12 months' (unless death occurred prior) available follow-up, with median follow-up of 9 months. Among these, 241 (75%) had TKI monotherapy, 23 (7%) had ICI monotherapy, and 58 had FOLFOX (18%) first-line treatment. Overall, patients had a high burden of AEs (mean 3.2), with the most prevalent being pain (75%), infection (39%), ascites (34%), and bleeding (29%). After adjusting for covariates, infection ($50 374), fever ($47 443), and diarrhea ($29 912) imposed the highest incremental annual costs versus patients without the AE. Up to 90% of costs were attributable to inpatient admissions, with 56% to 60% involving intensive care. Median 1-year survival was 32%. This real-world study demonstrated AE burden in alignment with previous clinical studies. Regardless of regimen used, AEs are associated with substantial healthcare costs due to inpatient care. Background Hepatocellular carcinoma (HCC) is an aggressive form of liver cancer with increasing incidence and mortality worldwide. For metastatic disease, systemic treatment is recommended. In addition to tumor characteristics, adverse events (AEs) may influence regimen choice. Aim To analyze healthcare burden among patients with advanced HCC, by treatment type and AEs observed. Methods Included were adult commercial and Medicare Advantage enrollees with ≥2 non‐diagnostic claims coded for HCC (the first setting the index date); ≥1 claim for systemic treatment of advanced/metastatic HCC; and continuous enrollment for a 6‐month pre‐index baseline period to ≥1 month post‐index (follow‐up). Patients were excluded by lack of systemic treatment; incomplete demographic information; pregnancy, liver transplant, other cancers during baseline or clinical trial participation. We describe patient characteristics, common AEs, overall survival, and healthcare burden in 2017 USD up to 12 months after initiation of tyrosine kinase inhibitor (TKI) monotherapy; immune checkpoint inhibitor (ICI) monotherapy; or FOLFOX combination therapy. Results The analytic sample consisted of 322 patients (median age 65.8 years, 76% male) who had 12 months' (unless death occurred prior) available follow‐up, with median follow‐up of 9 months. Among these, 241 (75%) had TKI monotherapy, 23 (7%) had ICI monotherapy, and 58 had FOLFOX (18%) first‐line treatment. Overall, patients had a high burden of AEs (mean 3.2), with the most prevalent being pain (75%), infection (39%), ascites (34%), and bleeding (29%). After adjusting for covariates, infection ($50 374), fever ($47 443), and diarrhea ($29 912) imposed the highest incremental annual costs versus patients without the AE. Up to 90% of costs were attributable to inpatient admissions, with 56% to 60% involving intensive care. Median 1‐year survival was 32%. Conclusions This real‐world study demonstrated AE burden in alignment with previous clinical studies. Regardless of regimen used, AEs are associated with substantial healthcare costs due to inpatient care. Abstract Background Hepatocellular carcinoma (HCC) is an aggressive form of liver cancer with increasing incidence and mortality worldwide. For metastatic disease, systemic treatment is recommended. In addition to tumor characteristics, adverse events (AEs) may influence regimen choice. Aim To analyze healthcare burden among patients with advanced HCC, by treatment type and AEs observed. Methods Included were adult commercial and Medicare Advantage enrollees with ≥2 non‐diagnostic claims coded for HCC (the first setting the index date); ≥1 claim for systemic treatment of advanced/metastatic HCC; and continuous enrollment for a 6‐month pre‐index baseline period to ≥1 month post‐index (follow‐up). Patients were excluded by lack of systemic treatment; incomplete demographic information; pregnancy, liver transplant, other cancers during baseline or clinical trial participation. We describe patient characteristics, common AEs, overall survival, and healthcare burden in 2017 USD up to 12 months after initiation of tyrosine kinase inhibitor (TKI) monotherapy; immune checkpoint inhibitor (ICI) monotherapy; or FOLFOX combination therapy. Results The analytic sample consisted of 322 patients (median age 65.8 years, 76% male) who had 12 months' (unless death occurred prior) available follow‐up, with median follow‐up of 9 months. Among these, 241 (75%) had TKI monotherapy, 23 (7%) had ICI monotherapy, and 58 had FOLFOX (18%) first‐line treatment. Overall, patients had a high burden of AEs (mean 3.2), with the most prevalent being pain (75%), infection (39%), ascites (34%), and bleeding (29%). After adjusting for covariates, infection ($50 374), fever ($47 443), and diarrhea ($29 912) imposed the highest incremental annual costs versus patients without the AE. Up to 90% of costs were attributable to inpatient admissions, with 56% to 60% involving intensive care. Median 1‐year survival was 32%. Conclusions This real‐world study demonstrated AE burden in alignment with previous clinical studies. Regardless of regimen used, AEs are associated with substantial healthcare costs due to inpatient care. Background Hepatocellular carcinoma (HCC) is an aggressive form of liver cancer with increasing incidence and mortality worldwide. For metastatic disease, systemic treatment is recommended. In addition to tumor characteristics, adverse events (AEs) may influence regimen choice. Aim To analyze healthcare burden among patients with advanced HCC, by treatment type and AEs observed. Methods Included were adult commercial and Medicare Advantage enrollees with ≥2 non‐diagnostic claims coded for HCC (the first setting the index date); ≥1 claim for systemic treatment of advanced/metastatic HCC; and continuous enrollment for a 6‐month pre‐index baseline period to ≥1 month post‐index (follow‐up). Patients were excluded by lack of systemic treatment; incomplete demographic information; pregnancy, liver transplant, other cancers during baseline or clinical trial participation. We describe patient characteristics, common AEs, overall survival, and healthcare burden in 2017 USD up to 12 months after initiation of tyrosine kinase inhibitor (TKI) monotherapy; immune checkpoint inhibitor (ICI) monotherapy; or FOLFOX combination therapy. Results The analytic sample consisted of 322 patients (median age 65.8 years, 76% male) who had 12 months' (unless death occurred prior) available follow‐up, with median follow‐up of 9 months. Among these, 241 (75%) had TKI monotherapy, 23 (7%) had ICI monotherapy, and 58 had FOLFOX (18%) first‐line treatment. Overall, patients had a high burden of AEs (mean 3.2), with the most prevalent being pain (75%), infection (39%), ascites (34%), and bleeding (29%). After adjusting for covariates, infection ($50 374), fever ($47 443), and diarrhea ($29 912) imposed the highest incremental annual costs versus patients without the AE. Up to 90% of costs were attributable to inpatient admissions, with 56% to 60% involving intensive care. Median 1‐year survival was 32%. Conclusions This real‐world study demonstrated AE burden in alignment with previous clinical studies. Regardless of regimen used, AEs are associated with substantial healthcare costs due to inpatient care. BACKGROUNDHepatocellular carcinoma (HCC) is an aggressive form of liver cancer with increasing incidence and mortality worldwide. For metastatic disease, systemic treatment is recommended. In addition to tumor characteristics, adverse events (AEs) may influence regimen choice. AIMTo analyze healthcare burden among patients with advanced HCC, by treatment type and AEs observed. METHODSIncluded were adult commercial and Medicare Advantage enrollees with ≥2 non-diagnostic claims coded for HCC (the first setting the index date); ≥1 claim for systemic treatment of advanced/metastatic HCC; and continuous enrollment for a 6-month pre-index baseline period to ≥1 month post-index (follow-up). Patients were excluded by lack of systemic treatment; incomplete demographic information; pregnancy, liver transplant, other cancers during baseline or clinical trial participation. We describe patient characteristics, common AEs, overall survival, and healthcare burden in 2017 USD up to 12 months after initiation of tyrosine kinase inhibitor (TKI) monotherapy; immune checkpoint inhibitor (ICI) monotherapy; or FOLFOX combination therapy. RESULTSThe analytic sample consisted of 322 patients (median age 65.8 years, 76% male) who had 12 months' (unless death occurred prior) available follow-up, with median follow-up of 9 months. Among these, 241 (75%) had TKI monotherapy, 23 (7%) had ICI monotherapy, and 58 had FOLFOX (18%) first-line treatment. Overall, patients had a high burden of AEs (mean 3.2), with the most prevalent being pain (75%), infection (39%), ascites (34%), and bleeding (29%). After adjusting for covariates, infection ($50 374), fever ($47 443), and diarrhea ($29 912) imposed the highest incremental annual costs versus patients without the AE. Up to 90% of costs were attributable to inpatient admissions, with 56% to 60% involving intensive care. Median 1-year survival was 32%. CONCLUSIONSThis real-world study demonstrated AE burden in alignment with previous clinical studies. Regardless of regimen used, AEs are associated with substantial healthcare costs due to inpatient care. |
| Author | Lal, Lincy S. Le, Lisa B. Seal, Brian Aly, Abdalla Peckous, Susan Teitelbaum, April |
| AuthorAffiliation | 1 Health Economics and Outcomes Research Optum Eden Prairie Minnesota USA 3 Hematology Oncology Associates San Diego California USA 2 US Medical Affairs AstraZeneca Gaithersburg Maryland USA |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/34494389$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.3322/caac.21590 10.4251/wjgo.v10.i5.108 10.1016/j.jhep.2017.09.016 10.1093/annonc/mdy151.097 10.1200/JCO.2017.77.6385 10.1007/s12029-019-00230-z 10.1093/annonc/mdy308 10.1111/apt.12450 10.2217/hep-2020-0024 10.1370/afm.1364 10.3322/caac.21492 10.1002/hep.28881 10.1634/theoncologist.2008-0185 10.1200/JCO.2015.64.7412 10.1016/S0140-6736(18)30207-1 10.1016/j.ctrv.2019.05.004 10.1016/j.jhep.2018.03.019 10.1177/1756283X15618129 10.1097/SLA.0000000000002889 10.1111/apt.15245 10.1093/aje/kwq433 |
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| Copyright | 2021 The Authors. published by Wiley Periodicals LLC. 2021 The Authors. Cancer Reports published by Wiley Periodicals LLC. 2022. This work is published under http://creativecommons.org/licenses/by/4.0/ (the "License"). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. |
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| Keywords | liver-directed chemotherapy hepatocellular carcinoma adverse events |
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American Society of Clinical Oncology Educational Book 39:248–260 year: 2019 ident: e_1_2_11_29_1 contributor: fullname: Grieb BC – ident: e_1_2_11_30_1 doi: 10.1093/annonc/mdy151.097 – ident: e_1_2_11_25_1 doi: 10.1200/JCO.2017.77.6385 – ident: e_1_2_11_28_1 doi: 10.1007/s12029-019-00230-z – ident: e_1_2_11_10_1 doi: 10.1093/annonc/mdy308 – ident: e_1_2_11_8_1 – ident: e_1_2_11_12_1 doi: 10.1111/apt.12450 – ident: e_1_2_11_3_1 doi: 10.2217/hep-2020-0024 – ident: e_1_2_11_21_1 doi: 10.1370/afm.1364 – ident: e_1_2_11_23_1 – volume: 25 start-page: SP61 issue: 2 year: 2019 ident: e_1_2_11_27_1 article-title: Humanistic and economic burden of hepatocellular carcinoma: systematic literature review publication-title: Am J Managed Care contributor: fullname: Kohn CG – ident: e_1_2_11_4_1 doi: 10.3322/caac.21492 – ident: e_1_2_11_16_1 doi: 10.1002/hep.28881 – ident: e_1_2_11_14_1 doi: 10.1634/theoncologist.2008-0185 – ident: e_1_2_11_26_1 – ident: e_1_2_11_5_1 doi: 10.1200/JCO.2015.64.7412 – ident: e_1_2_11_17_1 doi: 10.1016/S0140-6736(18)30207-1 – ident: e_1_2_11_24_1 doi: 10.1016/j.ctrv.2019.05.004 – ident: e_1_2_11_11_1 – ident: e_1_2_11_9_1 doi: 10.1016/j.jhep.2018.03.019 – ident: e_1_2_11_22_1 doi: 10.1177/1756283X15618129 – ident: e_1_2_11_7_1 doi: 10.1097/SLA.0000000000002889 – ident: e_1_2_11_18_1 doi: 10.1111/apt.15245 – ident: e_1_2_11_20_1 doi: 10.1093/aje/kwq433 |
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Hepatocellular carcinoma (HCC) is an aggressive form of liver cancer with increasing incidence and mortality worldwide. For metastatic disease,... Hepatocellular carcinoma (HCC) is an aggressive form of liver cancer with increasing incidence and mortality worldwide. For metastatic disease, systemic... Abstract Background Hepatocellular carcinoma (HCC) is an aggressive form of liver cancer with increasing incidence and mortality worldwide. For metastatic... Background Hepatocellular carcinoma (HCC) is an aggressive form of liver cancer with increasing incidence and mortality worldwide. For metastatic disease,... BACKGROUNDHepatocellular carcinoma (HCC) is an aggressive form of liver cancer with increasing incidence and mortality worldwide. For metastatic disease,... Abstract Background Hepatocellular carcinoma (HCC) is an aggressive form of liver cancer with increasing incidence and mortality worldwide. For metastatic... |
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| SubjectTerms | adverse events Cancer therapies Clinical trials Codes Comorbidity Disease Generalized linear models Health care expenditures Health care policy Hepatitis hepatocellular carcinoma Liver cancer liver‐directed chemotherapy Medicare Metastasis Mortality Original Patients Pharmacy Variables |
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| Title | Healthcare costs related to adverse events in hepatocellular carcinoma treatment: A retrospective observational claims study |
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