Liver Cancer Combined With Other Liver Diseases Driving Higher Death Rate And Health Care Costs For Us Seniors

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SAN FRANCISCO – Data from a new study presented this week at The Liver Meeting® – held by the American Association for the Study of Liver Diseases – found that hospitalizations and death are increasing among Medicare recipients with hepatocellular carcinoma, mainly due to co-existing alcoholic liver disease, hepatitis C virus infection (commonly called HCV) and nonalcoholic fatty liver disease (commonly called NAFLD).

Liver cancer is the fifth most common cancer and the second most common cause of cancer-related deaths worldwide. Hepatocellular carcinoma, or HCC, is the primary liver cancer, and its incidence is increasing in the United States. Researchers at the Inova Fairfax Hospital and the Betty and Guy Beatty Center for Integrated Research at Inova Health System in Falls Church, Va., conducted a study to assess recent trends in HCC-related deaths and health care utilization for US Medicare recipients.

“Both HCV and nonalcoholic steatohepatitis are expected to become more advanced with age,” says Zobair M. Younossi, MD, MPH, chairman, Department of Medicine, Inova Fairfax Medical Campus and professor of medicine at Virginia Commonwealth University. Dr. Younossi is a co-author of the new study. “In this context, an important complication of advanced liver disease is HCC. We believe that HCC is driven by NAFLD, which is increasing in prevalence, and will continue to place a financial burden on Medicare and should be addressed proactively.”

The study included a random sample of Medicare beneficiaries from 2005 to 2014. The researchers established diagnoses of HCC, HCV, hepatitis B virus (or HBV), alcoholic liver disease and NAFLD using ICD-9 codes. They analyzed trends in HCC rates, patient demographics, clinical features and utilization parameters.

The researchers examined 13,648 cases of HCC patients who sought inpatient or outpatient care. The average age of the patients in the study was 70; 62.8 percent were male; and 76 percent were white. The one-year death rate for this patient cohort was 45 percent. An increase in death rates was similar between males and females. The length of hospital stay duration decreased from 9.23 to 8.81 days over the study period, and the number of outpatient visits increased 1.86 to 3.18. In the inpatient care setting, one-year mortality was 64.4 percent, with an average length of stay of 8.6 days. In the outpatient care setting, the death rate was 40.6 percent.

Total charges for HCC care in the inpatient setting increased from $67,679 to $98,902 over the study period, and increased from $11,933 to $32,084 in the outpatient setting. People with HCC, HCV and alcoholic liver disease treated in the inpatient setting had a higher risk of death than patients with HCV alone – followed by those with HCC and NAFLD. Patients with HCC who also had other liver diseases – including HCV, alcoholic liver disease and NAFLD – also had higher health care charges than those with HCV alone, the study found.

“HCC has been one of the only solid tumors with increasing incidence in the U.S. Given the ongoing epidemic of NAFLD and its complications, this clinical picture is expected to get worse. HCC is also an expensive cancer with significant direct and indirect medical costs,” says Dr. Younossi. “Therefore, all payers, especially Medicare, will be affected by this increase in HCC. Hepatologists are not only involved in understanding the pathogenic pathways of HCC and developing treatment regimens, but also must educate all stakeholders, including payers and policymakers, about the importance of HCC.”

Dr. Younossi will present the study entitled “In Medicare Patients with Hepatocellular Carcinoma, Nonalcoholic Fatty Liver Disease is Among the Top Causes of Morality and Resource Utilization” on Monday, November 12 at 4:00 PM in Room 206/208. The corresponding abstract (number 0273) can be found in the journal, HEPATOLOGY.