The cost of palliative care for hepatocellular carcinoma in Hong Kong

Background: Hepatocellular carcinoma (HCC)is endemic in parts of Asia and A frica and most patients are not suitable for treatment with a curative appr oach. Little is known about the cost of palliative care for HCC. Objective: To determine: (i) patient-specific costs of palliative care of H CC; and (ii) individual factors that drive patient-specific costs and to de velop a model of cost per case under alternative circumstances. Methods: 204 patients with inoperable HCC were prospectively tracked from f irst hospitalisation until death for health service utilisation. A societal perspective of cost was taken, including costs of formal and informal serv ices 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 d ependent variable. Results: The median survival was 95 days and the mean observation period wa s 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 v alues were positively skewed. The regression analysis showed that age, days of observation and survival were negatively related to cost per observed d ay, and the Child-Pugh grading of severity of liver cirrhosis was positivel y related to cost per observed day. A sensitivity analysis based on the reg ression equation indicated that non-survivorship doubles the cost per case, increased severity as measured by the Child-Pugh Index adds about 50% to t he cost, and chemotherapy increases cost 2-fold. Conclusions: The relatively modest average cost per patient with HCC in Hon g Kong reflects the short median survival and subsequently the limited use of inpatient care and chemotherapy.