e., the loss of income associated with premature death). Thein et al.[6] in the current issue of Hepatology present a population-based study reporting the healthcare costs associated with HCC. The study, based on the Ontario Cancer Registry and linked administrative data, enrolled 2,341 cases of HCC identified in Ontario, Canada, between 2002 and 2008. The authors measured the “direct costs” of care, i.e., the expenditures for medical procedures and services used for the care of the disease. The main limitations of the study are the lack of tumor stage classification and the lack of etiological stratification.
Furthermore, it is worth noting that due to differences in epidemiology, medical practice, physicians selleck compound attitude and culture, patterns of treatment, patients’ preferences, and financial incentives these results cannot be transferred from one healthcare system
to another without proper adjustments. Despite these limitations, this important study provides us with innovative cost analyses, including: Estimates of the 5-year average net cost of a patient with HCC. As shown in Thein et al.’s article, selleck kinase inhibitor the per-patient 5-year net cost of care for HCC is higher than other cancers (about $77,000, range: $60,000 to $94,000). This is not surprising, because HCC usually occurs as a complication of liver cirrhosis. The presence of a chronic disease and of reduced liver function restricts therapeutic approaches and aggravates the costs of the disease. As discussed by the authors, these costs are also higher
than those calculated in prior studies reporting HCC costs in the U.S. and Taiwan.[7, 8] Clearly, several factors come into play, including types of data collected and local regulatory and reimbursement issues. Nevertheless, the methodology described in this article should Ketotifen be useful for further studies evaluating costs for specific healthcare systems. Estimates of the aggregate 5-year net costs of treating all patients with HCC from the perspective of a universal coverage healthcare system based on a whole population, and not on a sample. Thein et al.’s article does not provide estimates of the burden based on a more or less representative sample, but rather on the aggregate economic value of the care provided to the entire population. Should these figures be transferable to the U.S., the cost of managing the 20,000 new U.S. cases per year, not including morbidity and mortality costs, would be around one billion U.S. dollars. Phase-specific estimates of the direct costs of HCC. In Western countries, HCC is most often diagnosed in patients with liver cirrhosis undergoing an ultrasound (US) / alpha-fetoprotein (αFP)-based protocol of oncologic surveillance. The primary tumor is treated following a stage-based approach defined by the American Association for the Study of Liver Diseases (AASLD) guidelines. Patients showing a complete response undergo an intensive follow-up protocol.