Cost of living: Patients with cirrhosis plus liver cancer are bearing unusually high financial burdens

Cancer care is a major financial burden for many Americans and is expected to grow to more than $246 billion by 2030. This burden includes both direct costs like treatment and indirect ones like missed work. However, the financial burden of care for patients with a common type of liver cancer known as hepatocellular carcinoma (HCC) is less understood than for other types of cancers.

To gain a better understanding of the financial burden of HCC, a recent study analyzed health care costs for Medicare patients with HCC. The research team included Mohammad Karim, post-doctoral fellow from the Population Informatics Lab at the Texas A&M University School of Public Health; Hye-Chung Kum, professor at the School of Public Health; and colleagues from other institutions.

This study, published in the journal Clinical Gastroenterology and Hepatology, used nationally representative data on patients with HCC and a comparison group of people with cirrhosis who did not have HCC. The study findings were also recently highlighted in U.S. News and World Report.

HCC is one of the few cancers in the United States with a rising mortality rate. Treatments for HCC have improved significantly in recent years. These treatments include surgery, radiation and immune checkpoint inhibitors, but new treatments can often be expensive. This can add to the existing financial burdens of care for both patients and health care systems. Thus, understanding differences in costs among different patients with HCC is crucial for managing care in this population.

Karim and colleagues used data on patients from the 2018 Surveillance, Epidemiology and End Results (SEER)-Medicare database, a Medicare-linked data source that covers about 30% of the U.S. population. The SEER database includes data on cancer diagnosis and demographic characteristics, and Medicare data provides details on inpatient, outpatient and other health care costs.

The study included 4,525 patients older than 68 who had been diagnosed with HCC between January 2011 and December 2015 along with 4,525 matching cirrhosis patients without HCC. Of interest were the total cost of Medicare payments and total out-of-pocket liabilities for patients. The analysis included information on the stage of HCC, with patients having only one tumor measuring 5 cm or less in diameter being considered early stage patients. The researchers also examined demographic correlates like age, sex, race and ethnicity, poverty level and urban vs. rural status. The analysis also considered etiologic factors such as non-alcoholic fatty liver disease and comorbidities such as the presence of ascites, which is a condition where fluid collects in the abdomen.

Karim and colleagues found that patients with HCC had higher inpatient and outpatient care costs than those with cirrhosis without HCC. Early-stage HCC patients had lower Medicare and patient costs than people who had more and larger tumors. They also noted that the presence of comorbidities was associated with significantly higher Medicare and patient costs. It is possible that this is due to treatment complications stemming from reduced liver function and increased risk of toxicity.