Abstract
TACE is the standard-of-care first line treatment for intermediate stage HCC patients. Despite its routine use in this patient population, there is limited evidence regarding the direct HCRU. This study explores the resource impact to healthcare systems of TACE in Europe. A cross-sectional study was conducted in EU5 from January to May 2019. Interventional radiologists and radiation oncologists completed case report forms (CRFs) for patients classified as Stage B2 or B3 based on Barcelona Liver Cancer Clinic (BCLC) and Kinki subclassification criteria. Patients must have received TACE within 30 days of data capture. CRFs captured direct HCRU associated with each TACE. 317 CRFs were collected from 59 physicians. Median patient age was 65 years (range: 36-90), 70% were male, and 23% patients had hepatitis C. At data capture, 72% were Kinki criteria stage B2; 26% were B3. 39% patients had an ECOG score 0 versus 61% score 1; 82% were Child Pugh B class. Most (70%) received TACE as first HCC treatment. During first procedure, 72% patients received conventional TACE (28% DEB-TACE), predominantly as inpatients (81%), with a mean hospital stay of 3.7 days. Following TACE, 15% patients had an unplanned hospitalization, attributed to post-embolization syndrome in 40% of cases. Mean inpatient duration was an additional 3.5 days, with 12% patients admitted to intensive care. 32% patients received TACE as combination therapy. Since first TACE, patients received a mean 11.9 tests, including liver and kidney function tests and scans. Patients consulted HCPs a mean 4.4 times. HCRU burden of TACE therapy is considerable, with most patients requiring multiple days of hospitalization to administer or manage the effects of treatment, and a high demand on additional resources to monitor the clinical impact. There is a clear unmet need for treatments to minimize the disease burden in intermediate stage HCC.
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