Humanistic and Economic Burden of Advanced Hepatocellular Carcinoma: A Systematic Review

OBJECTIVES: A systematic literature review (SLR) was conducted to understand the humanistic burden of advanced hepatocellular carcinoma (aHCC) on patients’ health-related quality of life (HRQoL) and the economic burden (including costs and healthcare resource use) associated with the disease.

METHODS: The SLR was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidance. Electronic databases (Ovid MEDLINE and Embase (2008-2021)), and conference proceedings and SLRs (2017-2021) were searched for studies that met eligibility criteria.

RESULTS: Of 3044 records screened, 76 unique studies were identified (humanistic burden, n=47; economic burden, n=29). HRQoL was measured using both generic and cancer-related instruments with EORTC QLQ-C30 (n=20), EQ-5D-3L (n=10) and FACT-Hep (n=9) being the most frequently used. Data was sourced from 31 RCTs assessing systemic (n=24) and locoregional (n=7) therapies, and 16 observational studies. Results indicated that while treatment was shown to improve HRQoL in the short-term, HRQoL would still deteriorate in the long-term as disease progressed and adverse events (AEs) associated with treatment occurred. Economic studies were mainly conducted in the US (n=15) or Europe (n=10) and estimated costs as total costs per procedure or per patient per month (PPPM). In the US, mean total costs PPPM ranged between $9,892 – $21,163 for sorafenib and $13,648 – $22,304 for other systemic treatments. Seventeen studies reported resource use where the main cost drivers were treatment duration, units of treatment received, inpatient, outpatient, radiology, emergency room, laboratory and pharmacy costs.

CONCLUSIONS: HRQoL is negatively impacted by disease progression and treatment-related adverse events. The economic burden associated with aHCC is substantial and varies by country. It is largely driven by the high cost of treatments and resource use for disease management. This research highlights the unmet need of effective treatment to improve patient’s long-term HRQoL and reduce the economic burden to the healthcare system.