OBJECTIVES: Our real-world study aimed to assess the treatment patterns, healthcare resource utilization (HCRU) and costs associated with aHCC in Ontario, Canada.

METHODS: A retrospective cohort study was conducted using provincial-level databases from Ontario, Canada. Relevant ICD-10 and ICD-O-3 codes were used to identify patients diagnosed with aHCC between April 2010 and March 2019, with follow-up data available until March 2020. HCRU and costs were reported as per patient per year (PPPY) and were inflated to 2020 Canadian dollars.

RESULTS: A total of 7,322 patients were identified, of which 802 met the aHCC diagnosis criteria (82% male, median age of 66 years). Common comorbidities included diabetes (36%) and hypertension (29%). More than half (n=427) received first-line (1L) systemic therapy (ST; 98% sorafenib), a third (n=267) were untreated, and 9% (n=72) were given locoregional therapy without use of ST (51% transarterial chemoembolization [n=37], 46% stereotactic body radiation therapy [n=33], 8% transarterial embolization [n=6]). Only 4% (n=19) of 1L treated patients went on to receive a subsequent 2L treatment. The median time from diagnosis to 1L ST initiation was 2.3 months and median time on 1L ST was 2.4 months. The mean total cost per 1L treated patient per year was $53,752, with oral medications ($22,451) as the main cost driver followed by inpatient hospitalizations ($12,109). Treated patients had 1.9 inpatient hospitalizations, 9.8 outpatient clinic visits, 3.3 emergency department visits, and 5.7 cancer clinic visits PPPY.

CONCLUSIONS: In Ontario, the most common 1L treatment in aHCC was sorafenib and the associated HCRU and costs for this patient population was quite high. A quarter of the population was untreated, and a very limited number of patients went onto a 2L treatment, indicating a significant unmet need. Future studies will inform whether emerging treatments for aHCC will improve ST uptake and clinical outcomes.