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Original Article

Population-based risk factors and resource utilization for HCC: US perspective

, , &
Pages 2183-2191 | Accepted 02 Jul 2010, Published online: 29 Jul 2010
 

Abstract

Objective:

Hepatocellular carcinoma (HCC) is a deadly cancer with limited treatment options. HCC cases in the United States (US) were identified from a claims database to analyze the risk factors, the health care provider referral patterns, and treatment options in actual (real-world) clinical settings.

Methods:

MarketScan, a health care claims database from Thomas Reuters covering 18 million lives yearly and all US census regions from 2002 to 2008, was used to identify HCC patients and obtain data on patient characteristics, health care providers, and treatment utilization (i.e., medications, interventions).

Results:

HCC cases (n = 4406) were identified with an annual incidence of 0.4 per 1000 covered lives (i.e., those currently enrolled in a health care plan) from 2002 to 2008. Nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH) was the most common underlying etiologic risk factor (59%), followed by diabetes (36%) and hepatitis C virus infection (22%). Primary care/internal medicine providers managed the majority of cases (55%); a minority were seen by an oncologist (24%). Only 22% of cases known to have cirrhosis were undergoing HCC screening prior to diagnosis. Type of provider did not change significantly after the diagnosis was made. Systemic chemotherapy was the most commonly used treatment (32.8%); however, only 6% received sorafenib, the only approved drug for HCC. Limitations include lack of patient records and potential for physician coding variances.

Conclusion:

The incidence of HCC in the database was 0.4 per 1000 persons. NAFLD/NASH and type 2 diabetes mellitus, along with hepatitis C virus infection, were the major etiologic risk factors associated with HCC. This claims database analysis suggests a gap exists between screening and treatment guidelines and practice patterns, implying a need for greater health care provider awareness and education.

Transparency

Declaration of funding

Funding for this research was provided by Bayer Healthcare Pharmaceuticals.

Declaration of financial/other relationships

A.S. has disclosed that he is a full-time attending physician at Virginia Commonwealth University Healthcare System; has received research grants from sanofi-aventis, Salix, Gilead, Intercept and Roche; is a consultant/advisor for Bayer, Takeda, sanofi-aventis, Salix, Ikaria, Astellas, Pfizer, Gilead, Vertex, Exalenz, Onyx, Amylin and Norgine; is president of the American Association for the Study of Liver Diseases; and receives royalties from Up-To-Date. A.P. has disclosed that he is a full-time staff physician at Virginia Commonwealth University Healthcare System and has no other conflicts of interest to report. E.M. has disclosed that he is owner of Statlog Consulting, Inc., and is a consultant for Bayer. V.B. has disclosed that he is a full-time employee of and holds stock options in Bayer. All authors had access to the data and had a significant role in writing the manuscript.

Acknowledgments

The authors thank Denise Balog, PharmD, for editorial assistance.

Portions of this study were presented at Digestive Disease Week, May 30 – June 4, 2009, Chicago, IL, USA, and at 45th Annual Meeting American Society of Clinical Oncology, May 29 – June 2, 2009, Orlando, FL, USA.

Notes

*Bayer Healthcare Pharmaceuticals, Wayne, NJ, USA.

†SAS and all other SAS Institute Inc. product or service names are registered trademarks or trademarks of SAS Institute Inc., Cary, NC, USACitation13.

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