Cost of Hepatocellular Carcinoma in Türkiye: Results of a Delphi Panel Analysis

OBJECTIVES: Liver cancer is the sixth most commonly diagnosed cancer in the world with third place in cancer related deaths and hepatocellular carcinoma (HCC) accounts for 75-80% of liver cancers. This study aims to estimate the financial burden of HCC on the Social Security Institution (SSI) of Türkiye.

METHODS: A Modified Delphi Panel approach was used to estimate the costs of HCC treatment. A Healthcare Resource Utilization (HRU) questionnaire inquiring about the type, patient percentage and frequency of resources used at all treatment stages of resectable and unresectable HCC was sent to an expert panel of 12 experts. The answers from the first round were consolidated as averages, and a consensus document was prepared. This document was then discussed in a face-to-face meeting with the experts, and the consensus-building process was finalized. The costs were estimated based on the rules and reimbursement prices of the SSI.

RESULTS: The annual cost per patient for unresectable HCC was estimated to be 1,056,396 TRY (US$32,937 ) for the first line treatment and 495,342TRY (US$15,144) for the second line treatment. The annual cost per patient for resectable HCC after resection was estimated to be18,614TRY (US$580). The cost of oncologic drugs was the main cost item for both lines accounting for 91% of the first line and 81% of the second line. The total cost of HCC to the SSI was estimated to be 2,141,757,551 TRY (US$66,783,833) for unresectable and 37,082,609TRY (US$1,156,190) for resectable HCC. This represented 0.4% of total SSI expenditures.

CONCLUSIONS: Increasing risk factors such as obesity, type 2 diabetes and NAFLD in Türkiye may lead to an increase in HCC cases. Financial information about a disease is particularly valuable for planning preventive measures. Our findings indicate the need to consider the potential burden of HCC on the SSI budget in the future.