Open Access
Cost of Hepatocellular Carcinoma from the Payer’s Perspective in Türkiye: Results of a Delphi Panel Analysis
4
Polar Health Economics and Policy Consultancy
4
Roche Türkiye
4
Roche Türkiye
4
Başkent University
4
İstanbul University
4
Koç University
4
Bezmialem University
4
Ankara Yıldırım Beyazıt University
4
Bezmialem University
4
Antalya Training and Research Hospital
4
Gayrettepe Florence Nightingale Hospital
4
Medical Park Elazığ Hospital
4
Ege University
4
Altunizade Acıbadem Hospital
4
Hacettepe University
Abstract
Background: Liver cancer is the sixth most frequently diagnosed cancer in the world ranking third in cancer related deaths. Hepatocellular carcinoma (HCC) accounts for 75-80% of liver cancers. Despite a decrease in cases of Hepatitis B (HBV) and Hepatitis C (HCV) in recent years, it is predicted that HCC will continue to increase primarily due to the burden imposed by other risk factors such as obesity, type 2 diabetes and non-alcoholic fatty liver disease (NAFLD). Financial data regarding the cost burden of a disease on a reimbursement agency is crucial for predicting the impact of disease trends in the future.
Aim: This study aim to estimate the financial burden of HCC on the Social Security Institution (SSI) of Türkiye.
Methodology: The data needed to estimate the cost of HCC was gathered through expert opinions. The Modified Delphi Method was used to reach a consensus among experts. A Healthcare Resource Utilization (HRU) form was designed and sent to experts to be filled out independently. Twelve experts were selected through purposeful sampling (one general surgeon, one hepatologist and ten medical oncologists). The answers from the first round were consolidated as averages, and a consensus document was prepared. This document was then discussed in a face-to-face meeting with the experts, and the consensus-building process was finalized. The costs were estimated by using the rules and reimbursement prices of the SSI.
Results: The annual cost per patient for unresectable HCC was estimated as 1,056,396 TRY (US$32,937) for the first line treatment and 495,342TRY (US$15,144) for the second line treatment. The annual cost per patient for resectable HCC was estimated as 18,614TRY (US$580). The total cost of HCC to the SSI was estimated as 2,178,840,160 TRY (US$67,933,569) for unresectable cases and 37,082,609TRY (US$1,156,190) for resectable cases. This accounted for 0.4% of total SSI expenditures.
Conclusion: Increasing risk factors such as obesity, type 2 diabetes and NAFLD in Türkiye may result in an increase in HCC cases. Our findings indicate the need to consider the potential burden of HCC on the SSI budget in the future.
Keywords
Hepatocellular Carcinoma, Türkiye, Cost, Social Security Institution, Delphi Panel
References
Sung H, Ferlay J, Siegel RL, Laversanne M et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71:209–49.
Globocan. Turkey Cancer Fact Sheet [Internet]. 2020 [cited 2023 Oct 24]. Available from: https://gco.iarc.fr/today/data/factsheets/populations/792-turkey-fact-sheets.pdf.
Uzunalimoğlu O, Yurdaydın C, Çetinkaya H, Bozyaka H et al. Risk factors for Hepatocellular Carcinoma in Turkey. Dig Sci. 2001;46:1022–8.
Alacacıoğlu A, Somalı I, Şimşek İ, Astarcıoğlu İ et al. Epidemiology and Survival of Hepatocellular Carcinoma in Turkey: Outcome of Multicenter Study. Jpn J Clin Oncol. 2008;38(10):683–8.
Doğan E, Yalçın Ş, Koca D, Ölmez A. Clinicopathological Characteristics of Hepatocellular Carcinoma in Turkey. Asian Pac J Cancer Prev. 2012;13:2985–90.
Başsüllü N, Türkmen İ, Yaprak O, Dayangaç M et al. General Evaluation of Hepatectomy and Hepatocellular Carcinoma Cases. Turk J Pathol. 2011;27(3):2021–9.
Can A, Doğan E, Bayoğlu İV, Tatlı AM et al. Multicenter Epidemiologic Study on Hepatocellular Carcinoma in Turkey. Asian Pac J Cancer Prev. 15(6):2923–7.
Tözün N, Özdoğan O, Çakaloğlu Y, İdilman R et al. Seroprevalence of hepatitis B and C virus infections and risk factors in Turkey: a fieldwork TURHEP study. Clin Microbiol Infect. 2015;21.
Madihi S, Syed H, Lazar F, Zyad A, Benani A. A Systematic Review of the Current Hepatitis B Viral Infection and Hepatocellular Carcinoma Situation in Mediterranean Countries. BioMed Res Int. 2020.
İdilman R, Razavi H, Robbins-Scott S, Akarca US et al. A micro-elimination approach to addressing hepatitis C in Turkey. BMC Health Serv Res. 2020;20(249).
Huang DQ, Noureddin N, Ajmera V, Amangurbanova M et al. Type 2 diabetes, hepatic decompensation, and hepatocellular carcinoma in patients with non-alcoholic fatty liver disease: an individual participant-level data meta-analysis. Lancet Gastroenterol Hepatol. 2023;8:829–36.
Demirtaş CO, Brunetto MR. Surveillance for hepatocellular carcinoma in chronic viral hepatitis: Is it time to personalize it? Gastroenterol. 2021;27(33).
Kaya E, Yılmaz Y. Non-alcoholic fatty liver disease: A growing public health problem in Turkey. Turk J Gastroenterol. 2019;30(10):865,871.
Akkız H, Carr BI, Kendal YK, Guerra V et al. Characteristics of hepatocellular carcinoma aggressiveness factors in Turkish patients. Oncology. 2018;94(2):116–24.
Akarca US, Ünsal B, Sezgin O, Yalçın K et al. Characteristics of Newly Diagnosed Hepatocellular Carcinoma Patients Across Turkey: Prospective Multicenter Observational 3K Registry Study. Turk J Gastroenterol. 2021;32(12):1019–28.
Sağlık Bakanlığı. Türkiye Kanser İstatistikleri. Ankara: Sağlık Bakanlığı; 2022.
Beiderbeck D, Frevel N, Von der Gracht HA, Schmidt SA, Schweitzer VM. Preparing, conducting, and analyzing Delphi surveys: Cross-disciplinary practices, new directions, and advancements. MethodsX. 2021;8.
Koçkaya G, Yenilmez FB, Ergin G, Atikeler K, Tatar M. Cost effectiveness and economic value of obesity surgery for Turkey (CEVOS-T). Obes Med. 2016;1:33–7.
Tatar M, Şentürk A, Oğuzhan GE, Tuna E, Mat C, Başkan EB, et al. Cost of Treatment of Chronic Spontaneous Urticaria in Turkey. Health (N Y). 2016;08(11):1098–103.
Tatar M, Senturk A, Tuna E, Karabulut E, Caliskan Z, Arsava E, et al. Direct Treatment Costs Of Stroke In Turkey. Value Health. 2015;18(7):A388.
Turgay S, Aksu K, Dokuyucu O, Ertenli A, Gul A, Karaaslan Y, et al. Epidemiology of colchicine resistant Familial Mediterranean Fever disease (CrFMF) in Turkey. Pediatr Rheumatol. 2015;13(S1):P90, 1546-0096-13-S1-P90.
Tatar M, Senturk A, Tuna E, Bilginer B, Ulus A, Buyuktuna N, et al. Local Cost Study Of Treatment Of Venous Thromboembolism In Turkey. Value Health. 2015;18(7):A388–9.
Aksu K, Dokuyucu O, Ertenli A, Gul A, Karaaslan Y, Kasapcopur O, et al. Cost of Familial Mediterranean Fever (Fmf) Disease In Turkey. Value Health. 2015 Nov;18(7):A666.
Tatar M, Senturk A, Tuna E, Gurses C, Caglayan B, Firidin A. Direct Costs Of Epilepsy In Turkey: A Panel Approach. Value Health. 2016 Nov;19(7):A431.
Çavuşoğlu Y, Altay H, Aras D, Çelik A, Ertaş FS, Kılıçaslan B, et al. Cost-of-disease of Heart Failure in Turkey: A Delphi Panel-based Analysis of Direct and Indirect Costs. Balk Med J. 2022 Jul 22;39(4):282–9.
Eubank BH, Mohtadi NG, Lafave MR, Wiley JP, Bois AJ, Boorman RS, et al. Using the modified Delphi method to establish clinical consensus for the diagnosis and treatment of patients with rotator cuff pathology. BMC Med Res Methodol. 2016;16(1):56.
King PR, Beehler GP, Donnelly K, Funderburk JS, Wray LO. A practical guide to applying the Delphi technique in mental health treatment adaptation: The example of Enhanced Problem-Solving Training (E-PST). Prof Psychol Res Pract. 2021;52(4):376–86.
Sosyal Güvenlik Kurumu. Sosyal Güvenlik Kurumu Faaliyet Raporu 2023. Ankara; 2024.
Cullen K, Jones M,Pockett RD, Burton A, Cross TJS, Rowe IA,Paley L, Tataru D,, Alexander G, Marshall A, Fitzsimmons D. Cost of hepatocellular carcinoma to the national health service in England: a registry-based analysis. BMJ Open Gastro. 2023.
Abboud1 MI, Khan H, Medina-Morales E, Alsakarneh S, Jaber F,, Pyrsopoulos NT. Hepatocellular Carcinoma Incidence and Mortality in the USA by Sex, Age, and Race: A Nationwide Analysis of Two Decades. J Clin Transl Hepatol. 2024;12(2).
Claxton L,Walton M, Sharif-Hurst S, Wade R, Eastwood A,, Hodgson R. The Cost-Effectiveness of Selective Internal Radiation Therapies Compared With Sorafenib for Treating Advanced Unresectable Hepatocellular Carcinoma in the United Kingdom. Value Health. 2022;25(5):787–95.
Hucke F, Emmer H,Emmer R, Hucke M, Bota S, Fürstner M,, Klaus Hausegger 2, Reinhard Mittermair 3 and Markus Peck-Radosavljevic 1. Changes in the Epidemiology of Hepatocellular Carcinoma in Carinthia, Austria, 2012–2023. Cancers. 2023;15.
Nguyen AT, Si L, Lubel JS, Shackel N, Yee KC, Wilson M,, Bradshaw J, Hardy K, Palmer AJ, Blizzard CL, de Graaff B. Hepatocellular carcinoma surveillance based on the Australian Consensus Guidelines: a health economic modelling study. BMC Health Serv Res. 2023;23.
Nguang SH, Wu CK, Liang CM, Tai WC, Yang SC, Ku MK, Yuan LT, Wang JW, Tseng KL, Hung TH, Hsu PI, Wu DC,Chuah SK,, Hsu CN. Treatment and Cost of Hepatocellular Carcinoma: A Population-Based Cohort Study in Taiwan. Int J Env Res Public Health. 2018;15(12).
How to Cite
Tatar, M., Öztürk, B., Aydoğan, D., Köse, F., Dulundu, E., Laçin, Şahin, Dilber, F., Şendur, M. A., Şeker, M., Mustafa, K., Sağlam, S., Yıldız, B., Göker, E., Faysal, D., & Yalçın, Şuayıb. (2024). Cost of Hepatocellular Carcinoma from the Payer’s Perspective in Türkiye: Results of a Delphi Panel Analysis. Global Journal of Medical and Pharmaceutical Sciences, 3(09), 13-24. https://doi.org/10.55640/gjmps/Volume03Issue09-03
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