Liver transplantation (LT) is cost-effective in the primary treatment of Hepatocellular carcinoma (HCC). Loco-regional therapies (LRTs) have increased as both primary therapy for HCC as well as bridging in anticipation of LT. LRTs as bridging modalities prior to LT have been shown to reduce LT ineligibility. We have previously demonstrated no post-transplant outcome superiority of LRTs over no treatment. Given that clinical outcomes are not different, costs of care should help inform treatment choice.

We examined a novel Linkage of SRTR registry and Medicare claims data for 4669 LT recipients (2002-2015). Cost comparisons were performed between those receiving no treatment (n=2257) and those receiving LRT (n=2879). LRT was further divided into single modality LRT (n=1790) and combination modality LRT (n=622). Cost comparisons were conducted for the LT hospitalization and for post-LT care during yrs 1,2, and 3, and adjusted for tumor characteristics, donor and recipient factors.

LRT costs higher when compared to no treatment at the time of LT and post-transplant at 1,2 and 3 yrs (p <0.0001). Single modality LRT was less expensive than combination treatments at all the studied time points (figure 1). Recipient factors associated with cost included: larger tumor size (p <0.001), MELD >30 (p<0.001), recipient age <40 (p=0.0003). Donor ischemic time >13 hours significantly increased cost (p <0.001). Costs varied regionally, being significantly lower in region 7 compared to other regions (P=0.01).

LRT was associated with higher costs versus no treatment at time of LT and during yrs 1,2, and 3 post-LT, and combination modality therapy incurred higher cost than single modality therapy. Care of larger tumors was also more expensive. Modifiable strategies that may reduce costs care of LT recipients with HCC include decreasing ischemic time and earlier detection at smaller tumor size, especially in younger patients.

CITATION INFORMATION: Nazzal M., Ouseph R., Huiling X., Schnitzler M., Varma C., Randall H., Tuttle-Newhall J., Axelrod D., Lentine K. Cost Analysis of Loco-Regional Bridging Therapy for Hepatocellular Carcinoma: A National Study Am J Transplant. 2017;17 (suppl 3).

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