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The financial burden of contemporary care for hepatocellular carcinoma (HCC) is high for Medicare beneficiaries, a new analysis shows.

In the first year after a diagnosis of HCC, median Medicare payments exceed $65,000 and out-of-pocket costs top $10,000.

Even after accounting for the presence of cirrhosis and its related costs, metronidazole monistat together patients with HCC still have Medicare payments exceeding $50,000 and out-of-pocket costs topping $7000.

Amit Singal, MD, with UT Southwestern Medical Center in Dallas, and colleagues report their findings in Clinical Gastroenterology and Hepatology.

Common and Costly

HCC, the most common type of primary liver cancer, is a leading cause of death in patients with cirrhosis and is projected to become the third leading cause of cancer-related death in the United States by 2040, the researchers write.

The treatment landscape for HCC has changed over the past decade, with expanded surgical options, introduction of radiation-based therapies, and approval of immunotherapies — all of which are costly.

Yet the magnitude of financial burden of HCC therapy has been understudied, the researchers note.

To investigate, Singal and colleagues evaluated SEER-Medicare data for 4525 adults with traditional Medicare coverage who were diagnosed with HCC between 2011 and 2015 and a propensity-matched cohort of 4525 adults with cirrhosis but no HCC as a comparator group to tease out HCC-specific costs beyond costs related to cirrhosis. Patients in Medicare managed care were excluded because their cost information is not available in the database.

In the first year after a diagnosis of HCC, the median total Medicare payments were $66,338 (interquartile range [IQR], $30,931-$158,740) and patient liabilities (a proxy for out-of-pocket costs) were $10,008 (IQR, $5427-$19,669).

First-year costs were higher for patients with HCC than matched patients without HCC; the former group incurred median incremental Medicare payments of $50,110 (IQR, $14,242-$136,239) and patient liabilities of $7166 (IQR, $2401-$16,099), the investigators found.

Patients with early-stage HCC had lower incremental patient liabilities (median, $4195 vs $8238) and Medicare payments (median, $28,207 vs $59,509) than did their peers with larger tumor burden.

NAFLD Notably Tied to Higher Costs

Factors associated with higher HCC-related costs were nonalcoholic fatty liver disease (NAFLD) etiology, higher comorbidities, presence of ascites and hepatic encephalopathy, and larger tumor burden.

The researchers say that the link between NAFLD and higher costs is notable, given that NAFLD is an increasingly common underlying cause of HCC.

The link between larger tumor burden and higher costs underscores “another benefit of HCC surveillance and early detection,” they add.

“By separating the financial liabilities borne by patients and Medicare, we provide a clearer outlook of how cancer related costs are distributed between patients and public payers,” Singal and colleagues say.

“Our findings will inform policy interventions and will help formulate better financial supports targeting the most vulnerable HCC patients,” they conclude.

The study had no commercial funding. Singal has been on advisory boards and served as a consultant for Wako Diagnostics, Glycotest, Exact Sciences, Roche, Genentech, Bayer, Eisai, BMS, Exelixis, AstraZeneca, and TARGET RWE.

Clin Gastroenterol Hepatol. Published online November 24, 2022. Abstract

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