OBJECTIVES: Hepatocellular carcinoma (HCC) has a low survival rate, and accounts for approximately 30,000 mortalities each year in Japan. This study aimed to estimate the healthcare expenditures of HCC patients.

METHODS: Using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB), we randomly extracted a sample comprising 25% of all Japanese citizens who had been hospitalized at least once from April 2009 to December 2016. Patients with a recorded diagnosis of HCC were identified, and the month of the initial diagnosis was designated the index month. Patients with other cancers during the study period or without data for one year before the index month were excluded from analysis. The index month and the three preceding months were designated the initial phase, the six-month period preceding death was designated the terminal phase, and the period between these phases was designated the continuing phase. Healthcare expenditures were estimated according to the following treatment types: (1) hepatectomy; (2) locoregional therapy (LRT), including percutaneous ethanol injection, percutaneous microwave coagulation therapy, and radiofrequency ablation; (3) transcatheter arterial chemoembolization (TACE); (4) transcatheter arterial embokization (TAE); and (5) molecular targeted drugs (MTD). The mean monthly expenditures were calculated for each phase and treatment type.

RESULTS: We identified 7782 HCC patients during the study period. There were 3105, 1882, 2142, 396 and 251 patients who received monotherapy of hepatectomy, LRT, TACE, TAE, and MTD, respectively. The monthly healthcare expenditures during the initial/continuing/terminal phases for hepatectomy, LRT, TACE, TAE and MTD were $4931/$911/$6416, $2269/$1435/$3687, $2793/$1577/$4300, $2886/$1304/$5170 and $1914/$1295/$4428, respectively.

CONCLUSIONS: We estimated the healthcare expenditures of HCC patients for various phases and treatment types using the NDB. These estimates may have downstream applications in cost-effectiveness analyses of HCC screening programs and treatment approaches.