Hepatocellular Carcinoma: A Decade of Hospitalizations and Financial Burden in the United States

Abstract

Background: Despite a rise in the prevalence of hepatocellular carcinoma (HCC), data on HCC-related hospitalizations and financial burden are limited. The aim of this study was to evaluate temporal trends of HCC-related hospitalizations and evaluate its financial influence.

Materials and methods: Patients with the diagnosis of HCC, as reported by International Classification of Diseases-Ninth Revision code, were identified from the National Inpatient Sample databases from 2002-2011. The national estimates of hospitalizations were derived using appropriate sample weights. The change in total average charges per each hospitalization over the study period was calculated after adjusting for inflation.

Results: Hospitalizations related to HCC have increased from 24,024 in 2002 to 50,609 in 2011. Of these admissions, HCC was the principal diagnosis in 10,762 and 16,350 subjects in 2002 and 2011, respectively. Most were white males (male: 70%; white: 55%). The overall inpatient mortality was significantly decreased from 13.5% in 2002 to 9.9% in 2011 (P < 0.01). The same trend was also observed for the length of hospital stay (6.5 versus 5.6 days in 2002 and 2011, respectively). The inflation-adjusted cost per hospitalization increased by approximately 47% during the study period.

Conclusions: Despite the decrease in mortality rate and length-of-stay, hospitalizations and financial burden associated with HCC continued to increase between 2002 and 2011 in the United States.

Keywords: Financial burden; Hepatocellular carcinoma; Hospitalizations; Liver cancer; National Inpatient Sample database.

FIGURE

(A) Hospitalization related to the diagnosis of HCC in the United States from 2002–2011; (B) additional total hospital charges after adjusting for inflation for the diagnosis of HCC from 2002–2011, using the charges in 2002 as the reference; (C) average length-of-stay of hospitalization for the diagnosis of HCC from 2002–2011; and (D) inpatient mortality for the diagnosis of HCC from 2002–2011. HCC, hepatocellular carcinoma.