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The Cost of Palliative Care for Hepatocellular Carcinoma in Hong Kong

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Abstract

Background: Hepatocellular carcinoma (HCC)is endemic in parts of Asia and Africa and most patients are not suitable for treatment with a curative approach. Little is known about the cost of palliative care for HCC.

Objective: To determine: (i) patient-specific costs of palliative care of HCC; and (ii) individual factors that drive patient-specific costs and to develop a model of cost per case under alternative circumstances.

Methods: 204 patients with inoperable HCC were prospectively tracked from first hospitalisation until death for health service utilisation. A societal perspective of cost was taken, including costs of formal and informal services incurred by payers, caregivers and patients. Observational data from a large Hong Kong cancer care programme were used. A regression analysis was performed using formal costs only, with the cost per observed day as the dependent variable.

Results: The median survival was 95 days and the mean observation period was 153 days. The mean value per person for formal healthcare cost was 30 983 Hong Kong dollars [$HK] ($US3872, 1998 values). The distribution of cost valueswere positively skewed. The regression analysis showed that age, days of observation and survival were negatively related to cost per observed day, and the Child-Pugh grading of severity of liver cirrhosis was positively related to cost per observed day. A sensitivity analysis based on the regression equation indicated that nonsurvivorship doubles the cost per case, increased severity as measured by the Child-Pugh Index adds about 50% to the cost, and chemotherapy increases cost 2-fold.

Conclusions: The relatively modest average cost per patient with HCC in Hong Kong reflects the short median survival and subsequently the limited use of inpatient care and chemotherapy.

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Acknowledgements

This project is supported by a Full Project Grant of the Health Services Research Committee, Hospital Authority, Hong Kong. The authors would like to acknowledge the support of the Hospital Chief Executives and Finance Managers of Prince of Wales Hospital, Shatin Hospital and Bradbury Hospice during the course of this project.

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Authors and Affiliations

  1. Department of Clinical Oncology, Sir YK Pao Cancer Centre, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China

    Anthony T. C. Chan, Winnie Yeo, Maria Lai, Tony S. K. Mok, Thomas W. T. Leung & Philip J. Johnson

  2. Department of Public Health Sciences, University of Alberta, Canada

    Philip Jacobs

  3. Office of Educational Services, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong

    Clarke B. Hazlett

  4. Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong

    Wan Y. Lau

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  1. Anthony T. C. Chan
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  2. Philip Jacobs
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  3. Winnie Yeo
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  4. Maria Lai
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  5. Clarke B. Hazlett
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  6. Tony S. K. Mok
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  7. Thomas W. T. Leung
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  8. Wan Y. Lau
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  9. Philip J. Johnson
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Correspondence to Anthony T. C. Chan.

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Chan, A.T.C., Jacobs, P., Yeo, W. et al. The Cost of Palliative Care for Hepatocellular Carcinoma in Hong Kong. Pharmacoeconomics 19, 947–953 (2001). https://doi.org/10.2165/00019053-200119090-00006

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