OBJECTIVES: Assess the potential impact of fully adhering to the Barcelona Clinic Liver Cancer (BCLC) system – in terms of disease staging and treatment algorithm – on the disease burden and cost-of-illness associated with hepatocellular carcinoma (HCC) in Portugal.

METHODS: An individual-level, continuous-time, state-transition model was developed to simulate the progression of hypothetical HCC patients, through the disease stages and corresponding treatment algorithms suggested by the BCLC system, in the Portuguese National Health Service. The model was validated by a national panel of physicians specialized in the treatment of liver cancer patients. Inputs for the model, in terms of stage transitions, were derived from a targeted literature review. An expert panel provided further insights into disease incidence, disease prevalence, and healthcare resource utilization at each disease stage. Unit costs for healthcare resource utilization were collected from reliable national public sources.

RESULTS: Fully adhering to the BCLC system, the annual prevalence of HCC (including patients in remission) could be expected to keep increasing over the next five-year period, from 4.151 patients in 2023 to 4.851 patients in 2027. Annual mortality rates could slightly decrease from 29.8% in 2023 to 28.7% in 2027, however still leading to a total of 120,314 years of life lost due to premature mortality. Over the considered five-year period, HCC could account for €367,187,683.45 in health-care system costs, 44.3% of which attributable to systemic treatment related costs and 29.0% to liver-transplantation related costs.

CONCLUSIONS: This study provides valuable insights into the potential disease burden and cost-of-illness of HCC in Portugal, under the assumption of full adherence to the BCLC disease staging and treatment algorithm system. These findings can inform healthcare researchers on future investigation pathways and policymakers on resource allocation decisions, allowing for the effective management of HCC and potentially leading to improved patient outcomes.