Epidemiology and characteristics of patients (pts) with hepatocellular carcinoma (HCC) and care in the United States.

Abstract

231 Background: The incidence of liver and intrahepatic bile duct cancer, with HCC accounting for 72.7%, has doubled from 1992 to 2014 in the U.S. This study examined the latest epidemiology of HCC by analyzing 2 large U.S. databases. Methods: IBM MarketScan (IBM-MS) and Surveillance, Epidemiology, and End Results-National Program of Cancer Registries (SEER-NPCR) databases were analyzed separately. Pts (aged ≥ 18 years) with HCC as the primary cancer were identified from the IBM-MS database, who were covered by employer-provided commercial or Medicare Supplemental insurance. A new HCC diagnosis (Dx) was defined as the first HCC Dx using ICD-9/10 codes within the study period (Jan 2012-Sep 2017) and no other HCC Dx in the prior 12 months. Comorbidities, performance status, distribution of pts, and treatments received were described. In SEER-NPCR (Jan 2010-Dec 2014), a nationally representative patient sample was analyzed to describe the incidence and mortality of pts with HCC. Results: A total of 8,150 and 119,927 pts were identified in IBM-MS and SEER-NPCR, respectively. Pts were predominately male in both databases. The HCC incidence rates among the IBM-MS cohort were 5.9, 5.5, 4.9, and 4.7 per 100,000 person-years from 2013 to 2016, respectively. The downward trend in the HCC incidence rate post-2013 for this population coincided with the drop in HCC incidence rate from 2013 to 2014 in SEER-NPCR. Amongst the IBM-MS cohort, 6%, 36%, and 59% of pts had hepatitis B, hepatitis C, and cirrhosis at Dx, respectively. Most pts (88%) were considered having good performance status at Dx. Embolization and chemo/targeted therapies were the most common treatments received by pts irrespective of the disease stage (31% and 12%, respectively) and pts with de novo metastatic HCC (19% and 18%, respectively). About 44% of the HCC Dx occurred at hospital outpatient settings; 31% at inpatient settings and 23% at physician offices. Conclusions: This study identifies the recent epidemiologic changes in pts with HCC and characterizes their comorbidities in a commercially-insured and a U.S. representative population. These epidemiologic data may be important considerations for U.S. payers making coverage policies for pts with HCC.