CN4 Inpatient Treatment Patterns and Health Care Expenditures for Hepatocellular Carcinoma Among Population With Urban Basic Health Insurance in China

Abstract

To summarize current hepatocellular carcinoma (HCC) treatment patterns and health care expenditures during hospitalization among China's urban basic health insurance (BHI) beneficiaries and to identify trend in HCC treatment expenditures from 2008 to 2010. This was an encounter-based retrospective study using hospitalization claims database of the urban BHI enrollees. Study subjects were patients aged 18 years or older, with the China urban citizens' or employees' BHI plan, and had at least one hospital admission with a discharge diagnosis code of HCC (ICD-10 codes: C22.0 and C22.9) between 2008 and 2010. Descriptive statistical analyses of treatment patterns and expenditures were conducted. Totally, 2,765 hospitalization claims met inclusion criteria and were extracted from the database. Systemic therapy (predominantly traditional Chinese medicine) was involved in 72% of hospitalizations and transarterial chemoembolization was involved in 27%, followed by palliative therapy only (21%), local ablation (5%), liver resection (4%), and radiation (3%). Thirty-five percent of hospitalizations involved combined treatments. On average, HCC treatment expenditure was CNY11,243 per hospitalization in 2008–2010, with annualized increase of 21% from 2008 to 2010. The BHI plan covered a three-year average of 68% (CNY7,613) of total expenses, while copayment accounted for 20% (CNY2,234). Other self-paid expenses stabilized at CNY1,400 in 2008–2010. Length of stay dropped from 21.0 days in 2008 to 17.2 days in 2010, yet the daily expense rose from CNY460 to CNY848. Various treatments were used by hospitalized HCC patients with urban BHI coverage. The most often used treatment was systemic therapy. Health care expenditures per hospitalization increased tremendously from 2008 to 2010. However, the drugs patients purchased outside hospitals could not be captured in this database, which might underestimate the expenditures. Other limitations include lack of information at patient level and on disease stages and grades.