OBJECTIVES

: There is a paucity of UK-specific resource use data in unresectable HCC. Cost-effectiveness analyses have been based on surveys performed in 2007 and 2015, however clinicians have reported changes in resource utilisation, which could affect HCC-related health state (HS) costs. This study aimed to assess these changes for patients receiving selective internal radiation therapy (SIRT) and systemic therapy.

METHODS

: Resource use was elicited via a questionnaire from experienced medical professionals involved in care. The questionnaire (including background information, medical staff contacts, monitoring, hospitalisations and social care) was developed based on previous examples, guidelines and was validated by a medical oncologist. Face-to-face or telephone interviews were conducted. Unit costs were obtained from publicly available databases. Mean 2018/19 HS costs were compared to 2007 and 2015 results.

RESULTS

: Five interviews were conducted (two oncologists, one hepatologist, two specialist nurses). Pre-progression HS costs for SIRT and systemic therapy were £245.74 and £287.19/month respectively. One-off cost at progression was £207.79, and post-progression palliative care £499.37/month. Post-progression HS cost when on systemic therapy was same as pre-progression. Monthly costs were lower than in previous studies (by 55% and 80% pre- and post-progression respectively), mainly due to reduced hospitalisations and reduced use of funded social care. The main cost drivers pre- and post-progression were diagnostic procedures (53%) and medical staff contacts (45%) in the current study, and hospitalisations (41%) and social care (42%) in the 2007/2015 costs.

CONCLUSIONS

: Current results suggest important changes in clinical practice in HCC care since 2007, especially post-progression, due to increased familiarity with treatments and a shift from palliative care towards informal care. HS costs were also more dependent on patients receiving chemo-, radiation or palliative therapy, than on progression status, with costs doubling for palliative treatments. Further research would be beneficial using patient level information from large databases, registries.