There is considerable commentary regarding liver transplant vs resection for the treatment of hepatocellular carcinoma (HCC). While liver transplant provides longer survival when compared to resection; Milan criteria, organ availability, and UNOS reduction of exception points for HCC leave many patients with resection. One aspect missing in this analysis is the financial burden on patients/payers. Indeed, The Patient Protection and Affordable Care Act (Obama Care) prohibits the Secretary of Health and the Patient-Centered Outcome Research Institute to include cost in comparing treatment. To address this, we compiled billable events as a proxy for receivables, from diagnosis of HCC through resection or transplant, to death or last reported encounter of patients with HCC between 01/2011 and 12/2012.

On average, patients with HCC who underwent resection had a MELD of 12, survival of 652 days, and billable encounters of $316,873 or $2,904/day. In contrast, patients that received a liver transplant had a MELD of 19, survival of 1579 days, and billable encounters of $704,291 or $2,622 per day.

Surgery represents the largest category of treatment of patients with HCC ($88,020 or 28% & $175,457 or 26% resection & transplant respectively). Moreover, the cost effectiveness of treatment was directly proportional to length of survival. The longer overall survival in patients transplanted with HCC ultimate diminishes the financial burden long term compared to resection. This endpoint measure occurs after 2 years survival. In patients who received a liver transplant and died within 2 years, the financial burden was on average $7,450/day. In contrast, patients who survived longer > 2 years had a financial burden of $320/day.

In conclusion, liver transplant offers both patients and payers a significant advantage over liver resection for eligible patients with HCC when predicted survival is greater than 2yrs. In a health care climate aiming to contain costs and evaluate value based treatment paradigms, financial burden should be included in the decision analysis. A balance needs to be drawn between survival and financial burdens.

CITATION INFORMATION: Butler J., Skill N., Kubal C., O'Brien D., Kays J., Fridell J., Maluccio M. Financial Burden of Liver Transplant vs Resection for HCC Am J Transplant. 2017;17 (suppl 3).

« Back to 2018 American Transplant Congress