IntroductionLimited data are available regarding treatment patterns and costs for patients with advanced hepatocellular cancer (HCC). Sorafenib is the only approved systemic therapy for HCC. We hypothesized that the absence of additional options for subsequent therapy may lead to widely divergent treatment patterns. MethodsUsing Medstat MarketScan® commercial claims data, we identified adult patients with a diagnosis of primary liver cancer (ICD-9-CM code=155.0) with a sorafenib claim during July 2006 - June 2010. To identify unresectable disease, patients were excluded if they had undergone procedures of potentially curative intent within 3 months prior to or after sorafenib. To identify first-line sorafenib, patients were excluded if they received other chemotherapy within 6 months prior to sorafenib. Patients were excluded if they had any other cancer diagnosis. Analyzed data included patient characteristics, anti-cancer therapies (drugs and procedures), resource use, and costs. Patients were observed until end of enrollment in health care plan or last day of available Marketscan data. Data were summarized descriptively; t-tests were used to compare continuous variables, chi-square tests to compare categorical variables, and Wilcoxon signed-rank tests to compare cost variables. Results548 patients were identified as receiving first-line sorafenib, of whom 176 (32%) received concomitant and/or subsequent anti-cancer therapy (AC-Y), 320 (58%) received no other anti-cancer therapy (AC-N), and 52 (9%) could not be classified. Mean age was 63.5 years and 81% were male. Characteristics for AC-Y and AC-N were similar with exception of younger age for AC-N (mean 61.4 vs 64.5 years [p=0.003]). Overall, mean follow-up was longer for AC-Y (300 vs 213 days [p<0.001]), but time from last active treatment to end of observation was similar (mean 102 vs 128 days [p=0.076]). Overall mean total costs (including sorafenib) per patient were higher for AC-Y ($100,253 vs $49,714 [p<0.001]), but were similar in the period following the last active treatment ($15,334 vs $17,160 [p=0.375]). Component care costs for AC-Y and AC-N were $45,745 (46% of total) vs $15,656 (31%) for outpatient care, $29,425 (29%) vs $21,029 (42%) for pharmacy, and $25,083 (25%) vs $13,028 (26%) for hospitalization, respectively. Sorafenib accounted for >80% of pharmacy costs. After active treatment, component costs for AC-Y vs AC-N for outpatient care were $7486 (49%) vs $8187 (48%), pharmacy $1606 (10%) vs $1566 (9%), and hospitalization $6241 (41%) vs $7407 (43%), respectively. For AC-Y patients, 44% underwent embolization concomitant with sorafenib; 20% went on to receive additional chemotherapy and 29% underwent embolization after sorafenib. The most common chemotherapy agents (excluding sorafenib) during active treatment were doxorubicin, capecitabine, and cisplatin. ConclusionApproximately one-third of advanced HCC patients who received first-line sorafenib receive additional anti-cancer therapy. Overall costs for these patients are higher, but accrued over a longer period of time. Once anti-cancer therapy ceases, resource use and costs are similar for all patients who initially received sorafenib. Over the entire observation period, hospitalization contributes the least to overall costs. As with other retrospective claims analyses, limitations include coding processes, lack of direct clinical data, and potential transition of patients to different health care plans.