OBJECTIVES : Advanced hepatocellular carcinoma (HCC) generates a considerable economic burden. This retrospective study describes healthcare resource utilization (HCRU) and costs in patients with advanced HCC receiving the oral tyrosine kinase inhibitors (TKI), regorafenib and cabozantinib.

METHODS Adults with ≥1 diagnosis for HCC and ≥1 claim for oral TKI at or after the diagnosis were identified in the IBM MarketScan Commercial and Medicare Supplemental databases between 04/30/2016 and 04/30/2019 (index date=date of initial TKI). Patients were continuously enrolled from 6 months before to ≥3 months after the index date with no prior evidence of liver resection, liver transplant, radiofrequency ablation, or prior use of regorafenib or cabozantinib. They were followed from the index date to the earliest of data cutoff or end of enrollment. Demographics, persistence (continuous TKI therapy without >60 days gap), HCRU and costs (while TKI-persistent) per-patient-per-month (PPPM) were evaluated.

RESULTS : A total of 109 patients (median age=61 years; 71% male) met eligibility criteria, of which 88.1% received regorafenib and 36.7% had evidence of metastatic HCC before or at index date. Only 31.2% of patients were persistent and the median (interquartile range, IQR) persistence time was 133.5 (94.5-200.5) days. Among persistent patients, 88.2% had outpatient visits (median=8.5, IQR=4-14 visits), 26.5% had inpatient admissions, and 23.5% visited an emergency department. While persistent, median (IQR) total all-cause costs PPPM were $16,106 (15,167-19,792), median (IQR) total all-cause medication costs PPPM were $15,091 (12,426-16,475), and TKI pharmacy costs PPPM were $14,672 (11,151-16,381), while patient out-of-pocket pharmacy costs PPPM were $59.40 (9-101).

CONCLUSIONS : This retrospective analysis demonstrates the substantial healthcare resource utilization and costs, driven primarily by TKI pharmacy costs in patients with advanced HCC. These findings can inform future cost-effectiveness analyses and health care resource allocation. Specific, differences between regorafenib and cabozantinib will be displayed in future studies.