(300) Economic burden of recurrence in early-stage hepatocellular carcinoma (HCC) treated with curative intent: A retrospective analysis of SEER-Medicare data

Background: : Patients with early-stage HCC who undergo curative intent therapy remain at risk of disease recurrence. However, real-world evidence on the economic burden associated with disease recurrence in these patients is currently limited.

Objective: : To quantify the economic burden associated with disease recurrence among patients with early-stage HCC treated with curative intent therapy.

Methods: : Patients with early-stage HCC who have achieved complete radiological response via surgical resection or local ablation were identified from the SEER-Medicare database (2007-2017). Patients with evidence of recurrence following curative therapy were grouped into the recurrence cohort and were followed from the date of recurrence (index date). Patients who did not have evidence of recurrence were grouped into the recurrence-free cohort and were followed from an assigned index date based on the distribution of time between curative therapy and recurrence in the recurrence cohort. Healthcare resource utilization (HRU) and healthcare costs (2022 USD) were compared between cohorts with and without recurrence, adjusting for demographic and clinical characteristics.

Results: : A total of 309 and 302 patients with and without recurrence, respectively, were included in the analysis. Mean age was 75.0 and 74.5 years (p=0.21), with males comprising 66.3% and 60.3% (p=0.12) of patients in the recurrence and non-recurrence cohorts, respectively. Mean follow-up was 20.8 and 22.0 months, respectively. The recurrence cohort had significantly higher mean per patient per month (PPPM) all-cause outpatient (3.2 vs. 2.3; adjusted incidence rate ratio [aIRR] = 1.2, p< 0.01) and inpatient visits (0.4 vs. 0.1; aIRR=2.1; p< 0.01). HCC-related outpatient and inpatient visits were also higher in the recurrence cohort. Mean PPPM all-cause total healthcare costs were significantly higher in the recurrence cohort ($14,697 vs. $6,223; adjusted cost difference: $9,205; p< 0.01). PPPM HCC-related total costs were $11,202 vs. $3,313 (adjusted cost difference: $10,021; p< 0.01). Inpatient costs were the major driver for all-cause and HCC-related total costs in the recurrence cohort vs. non-recurrence cohort.

Conclusions: : Study findings suggest significant resource use burden and high total healthcare costs for patients with early-stage HCC who experience recurrence after curative therapy compared to those who remain recurrence free. These data indicate a need for future novel therapies with recurrence-free survival benefit in the management of early-stage HCC patients.

Sponsorship:: Merck & Co., Inc.