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Patterns of treatment and costs of intermediate and advanced hepatocellular carcinoma management in four Italian centers.

Colombo GL, Cammà C, Attili AF, Ganga R, Gaeta GB, Brancaccio G, Franzini JM, Volpe M, Turchetti G - Ther Clin Risk Manag (2015)

Bottom Line: Both in the intermediate and in the advanced stage of the disease, variability in treatment patterns among centers was observed.The present analysis raises for the first time the awareness of the overall costs incurred by the Italian National Healthcare System for different treatments used in intermediate and advanced HCC.Further investigations would be important to better understand the effective health care resource usage.

View Article: PubMed Central - PubMed

Affiliation: Department of Drug Sciences, University of Pavia, Pavia, Italy.

ABSTRACT

Background: Hepatocellular carcinoma (HCC) is a severe health condition associated with high hospitalizations and mortality rates, which also imposes a relevant economic burden.

Purpose: The aim of the present survey is to investigate treatment strategies and related costs for HCC in the intermediate and advanced stages of the disease.

Patients and methods: The survey was conducted in four Italian centers through structured interviews with physicians. Information regarding the stage of disease, treatments performed, and related health care resource consumption was included in the questionnaire. Direct health care cost per patient associated with the most relevant treatments such as sorafenib, transarterial chemoembolization (TACE), and transarterial radioembolization (TARE) was evaluated.

Results: Between 2013 and 2014, 285 patients with HCC were treated in the four participating centers; of these, 80 were in intermediate stage HCC (Barcelona Clinic Liver Cancer Classification [BCLC] B), and 57 were in the advanced stage of the disease (BCLC C). In intermediate stage HCC, the most frequent first-line treatment was TACE (63%) followed by sorafenib (15%), radiofrequency ablation (14%), and TARE (1.3%). In the advanced stage of HCC, the most frequently used first-line therapy was sorafenib (56%), followed by best supportive care (21%), TACE (18%), and TARE (3.5%). The total costs of treatment per patient amounted to €12,214.54 with sorafenib, €13,418.49 with TACE, and €26,106.08 with TARE. Both in the intermediate and in the advanced stage of the disease, variability in treatment patterns among centers was observed.

Conclusion: The present analysis raises for the first time the awareness of the overall costs incurred by the Italian National Healthcare System for different treatments used in intermediate and advanced HCC. Further investigations would be important to better understand the effective health care resource usage.

No MeSH data available.


Related in: MedlinePlus

Updated staging system and treatment strategy.Notes: Reprinted from the Journal of Hepatology, Volume 56, European Association for the Study of the Liver; European Organisation for Research and Treatment of Cancer, EASL–EORTC clinical practice guidelines: management of hepatocellular carcinoma. Pages 908–943. Copyright 2012, with permission from Elsevier.15Abbreviations: HCC, hepatocellular carcinoma; PST, performance status test; CLT, cadaveric liver transplantation; LDLT, liver donor liver transplantation; RF, radio frequency ablation; PEI, percutaneous ethanol injection; TACE, transarterial chemoembolization; OS, overall survival.
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f1-tcrm-11-1603: Updated staging system and treatment strategy.Notes: Reprinted from the Journal of Hepatology, Volume 56, European Association for the Study of the Liver; European Organisation for Research and Treatment of Cancer, EASL–EORTC clinical practice guidelines: management of hepatocellular carcinoma. Pages 908–943. Copyright 2012, with permission from Elsevier.15Abbreviations: HCC, hepatocellular carcinoma; PST, performance status test; CLT, cadaveric liver transplantation; LDLT, liver donor liver transplantation; RF, radio frequency ablation; PEI, percutaneous ethanol injection; TACE, transarterial chemoembolization; OS, overall survival.

Mentions: The Barcelona Clinic Liver Cancer Classification (BCLC) correlates stages of the disease with treatment modalities, and identifies five stages of HCC (0, A, B, C, and D) according to preestablished prognostic variables and treatment modalities for each stage of the disease, thus providing both prognostic prediction and treatment allocation recommendations.13 The American Association for the Study of Liver Disease (AASLD) guidelines 2010,14 the European Association for the Study of the Liver (EASL) guidelines 2012,15 and the Italian Association for the Study of the Liver (AISF 2012)16 are the most updated guidelines for the treatment of HCC and include staging and prognostic–therapeutic stratification (EASL–BCLC guidelines) (Figure 1).


Patterns of treatment and costs of intermediate and advanced hepatocellular carcinoma management in four Italian centers.

Colombo GL, Cammà C, Attili AF, Ganga R, Gaeta GB, Brancaccio G, Franzini JM, Volpe M, Turchetti G - Ther Clin Risk Manag (2015)

Updated staging system and treatment strategy.Notes: Reprinted from the Journal of Hepatology, Volume 56, European Association for the Study of the Liver; European Organisation for Research and Treatment of Cancer, EASL–EORTC clinical practice guidelines: management of hepatocellular carcinoma. Pages 908–943. Copyright 2012, with permission from Elsevier.15Abbreviations: HCC, hepatocellular carcinoma; PST, performance status test; CLT, cadaveric liver transplantation; LDLT, liver donor liver transplantation; RF, radio frequency ablation; PEI, percutaneous ethanol injection; TACE, transarterial chemoembolization; OS, overall survival.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4621183&req=5

f1-tcrm-11-1603: Updated staging system and treatment strategy.Notes: Reprinted from the Journal of Hepatology, Volume 56, European Association for the Study of the Liver; European Organisation for Research and Treatment of Cancer, EASL–EORTC clinical practice guidelines: management of hepatocellular carcinoma. Pages 908–943. Copyright 2012, with permission from Elsevier.15Abbreviations: HCC, hepatocellular carcinoma; PST, performance status test; CLT, cadaveric liver transplantation; LDLT, liver donor liver transplantation; RF, radio frequency ablation; PEI, percutaneous ethanol injection; TACE, transarterial chemoembolization; OS, overall survival.
Mentions: The Barcelona Clinic Liver Cancer Classification (BCLC) correlates stages of the disease with treatment modalities, and identifies five stages of HCC (0, A, B, C, and D) according to preestablished prognostic variables and treatment modalities for each stage of the disease, thus providing both prognostic prediction and treatment allocation recommendations.13 The American Association for the Study of Liver Disease (AASLD) guidelines 2010,14 the European Association for the Study of the Liver (EASL) guidelines 2012,15 and the Italian Association for the Study of the Liver (AISF 2012)16 are the most updated guidelines for the treatment of HCC and include staging and prognostic–therapeutic stratification (EASL–BCLC guidelines) (Figure 1).

Bottom Line: Both in the intermediate and in the advanced stage of the disease, variability in treatment patterns among centers was observed.The present analysis raises for the first time the awareness of the overall costs incurred by the Italian National Healthcare System for different treatments used in intermediate and advanced HCC.Further investigations would be important to better understand the effective health care resource usage.

View Article: PubMed Central - PubMed

Affiliation: Department of Drug Sciences, University of Pavia, Pavia, Italy.

ABSTRACT

Background: Hepatocellular carcinoma (HCC) is a severe health condition associated with high hospitalizations and mortality rates, which also imposes a relevant economic burden.

Purpose: The aim of the present survey is to investigate treatment strategies and related costs for HCC in the intermediate and advanced stages of the disease.

Patients and methods: The survey was conducted in four Italian centers through structured interviews with physicians. Information regarding the stage of disease, treatments performed, and related health care resource consumption was included in the questionnaire. Direct health care cost per patient associated with the most relevant treatments such as sorafenib, transarterial chemoembolization (TACE), and transarterial radioembolization (TARE) was evaluated.

Results: Between 2013 and 2014, 285 patients with HCC were treated in the four participating centers; of these, 80 were in intermediate stage HCC (Barcelona Clinic Liver Cancer Classification [BCLC] B), and 57 were in the advanced stage of the disease (BCLC C). In intermediate stage HCC, the most frequent first-line treatment was TACE (63%) followed by sorafenib (15%), radiofrequency ablation (14%), and TARE (1.3%). In the advanced stage of HCC, the most frequently used first-line therapy was sorafenib (56%), followed by best supportive care (21%), TACE (18%), and TARE (3.5%). The total costs of treatment per patient amounted to €12,214.54 with sorafenib, €13,418.49 with TACE, and €26,106.08 with TARE. Both in the intermediate and in the advanced stage of the disease, variability in treatment patterns among centers was observed.

Conclusion: The present analysis raises for the first time the awareness of the overall costs incurred by the Italian National Healthcare System for different treatments used in intermediate and advanced HCC. Further investigations would be important to better understand the effective health care resource usage.

No MeSH data available.


Related in: MedlinePlus