PMID- 34494389
OWN - NLM
STAT- MEDLINE
DCOM- 20220524
LR  - 20230916
IS  - 2573-8348 (Electronic)
IS  - 2573-8348 (Linking)
VI  - 5
IP  - 5
DP  - 2022 May
TI  - Healthcare costs related to adverse events in hepatocellular carcinoma treatment: 
      A retrospective observational claims study.
PG  - e1504
LID - 10.1002/cnr2.1504 [doi]
LID - e1504
AB  - BACKGROUND: Hepatocellular carcinoma (HCC) is an aggressive form of liver cancer 
      with increasing incidence and mortality worldwide. For metastatic disease, 
      systemic treatment is recommended. In addition to tumor characteristics, adverse 
      events (AEs) may influence regimen choice. AIM: To analyze healthcare burden 
      among patients with advanced HCC, by treatment type and AEs observed. METHODS: 
      Included were adult commercial and Medicare Advantage enrollees with >/=2 
      non-diagnostic claims coded for HCC (the first setting the index date); >/=1 claim 
      for systemic treatment of advanced/metastatic HCC; and continuous enrollment for 
      a 6-month pre-index baseline period to >/=1 month post-index (follow-up). Patients 
      were excluded by lack of systemic treatment; incomplete demographic information; 
      pregnancy, liver transplant, other cancers during baseline or clinical trial 
      participation. We describe patient characteristics, common AEs, overall survival, 
      and healthcare burden in 2017 USD up to 12 months after initiation of tyrosine 
      kinase inhibitor (TKI) monotherapy; immune checkpoint inhibitor (ICI) 
      monotherapy; or FOLFOX combination therapy. RESULTS: The analytic sample 
      consisted of 322 patients (median age 65.8 years, 76% male) who had 12 months' 
      (unless death occurred prior) available follow-up, with median follow-up of 
      9 months. Among these, 241 (75%) had TKI monotherapy, 23 (7%) had ICI 
      monotherapy, and 58 had FOLFOX (18%) first-line treatment. Overall, patients had 
      a high burden of AEs (mean 3.2), with the most prevalent being pain (75%), 
      infection (39%), ascites (34%), and bleeding (29%). After adjusting for 
      covariates, infection ($50 374), fever ($47 443), and diarrhea ($29 912) imposed 
      the highest incremental annual costs versus patients without the AE. Up to 90% of 
      costs were attributable to inpatient admissions, with 56% to 60% involving 
      intensive care. Median 1-year survival was 32%. CONCLUSIONS: This real-world 
      study demonstrated AE burden in alignment with previous clinical studies. 
      Regardless of regimen used, AEs are associated with substantial healthcare costs 
      due to inpatient care.
CI  - (c) 2021 The Authors. Cancer Reports published by Wiley Periodicals LLC.
FAU - Lal, Lincy S
AU  - Lal LS
AUID- ORCID: 0000-0002-9123-2434
AD  - Health Economics and Outcomes Research, Optum, Eden Prairie, Minnesota, USA.
FAU - Aly, Abdalla
AU  - Aly A
AD  - US Medical Affairs, AstraZeneca, Gaithersburg, Maryland, USA.
FAU - Le, Lisa B
AU  - Le LB
AD  - Health Economics and Outcomes Research, Optum, Eden Prairie, Minnesota, USA.
FAU - Peckous, Susan
AU  - Peckous S
AD  - Health Economics and Outcomes Research, Optum, Eden Prairie, Minnesota, USA.
FAU - Seal, Brian
AU  - Seal B
AD  - US Medical Affairs, AstraZeneca, Gaithersburg, Maryland, USA.
FAU - Teitelbaum, April
AU  - Teitelbaum A
AD  - Hematology Oncology Associates, San Diego, California, USA.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20210907
PL  - United States
TA  - Cancer Rep (Hoboken)
JT  - Cancer reports (Hoboken, N.J.)
JID - 101747728
RN  - 0 (Protein Kinase Inhibitors)
SB  - IM
MH  - Adult
MH  - Aged
MH  - *Carcinoma, Hepatocellular/therapy
MH  - Female
MH  - Health Care Costs
MH  - Humans
MH  - *Liver Neoplasms/therapy
MH  - Male
MH  - Medicare
MH  - Protein Kinase Inhibitors
MH  - Retrospective Studies
MH  - United States/epidemiology
PMC - PMC9124510
OTO - NOTNLM
OT  - adverse events
OT  - hepatocellular carcinoma
OT  - liver-directed chemotherapy
COIS- LSL, LBL, and SP were employed by Health Economics and Outcomes Research, Optum, 
      Eden Prairie, MN; AA and BS were employed by US Medical Affairs, AstraZeneca, 
      Gaithersburg, MD; and AT was affiliated with Hematology Oncology Associates, 
      Carlsbad, CA, at the time this work was conducted. AA holds stock in AstraZeneca. 
      No employment was contingent upon publication of this work. Authors declare there 
      are no other conflicts of interest.
EDAT- 2021/09/09 06:00
MHDA- 2022/05/25 06:00
PMCR- 2021/09/07
CRDT- 2021/09/08 07:13
PHST- 2021/05/04 00:00 [revised]
PHST- 2021/03/04 00:00 [received]
PHST- 2021/06/17 00:00 [accepted]
PHST- 2021/09/09 06:00 [pubmed]
PHST- 2022/05/25 06:00 [medline]
PHST- 2021/09/08 07:13 [entrez]
PHST- 2021/09/07 00:00 [pmc-release]
AID - CNR21504 [pii]
AID - 10.1002/cnr2.1504 [doi]
PST - ppublish
SO  - Cancer Rep (Hoboken). 2022 May;5(5):e1504. doi: 10.1002/cnr2.1504. Epub 2021 Sep 
      7.