Cost of Hepatocellular Carcinoma from the Payer’s Perspective in Türkiye: Results of a Delphi Panel Analysis

Background: Liver cancer is the sixth most frequently diagnosed cancer in the world ranking third in cancer related deaths. Hepatocellular carcinoma (HCC) accounts for 75-80% of liver cancers. Despite a decrease in cases of Hepatitis B (HBV) and Hepatitis C (HCV) in recent years, it is predicted that HCC will continue to increase primarily due to the burden imposed by other risk factors such as obesity, type 2 diabetes and non-alcoholic fatty liver disease (NAFLD). Financial data regarding the cost burden of a disease on a reimbursement agency is crucial for predicting the impact of disease trends in the future. Aim: This study aim to estimate the financial burden of HCC on the Social Security Institution (SSI) of Türkiye. Methodology: The data needed to estimate the cost of HCC was gathered through expert opinions. The Modified Delphi Method was used to reach a consensus among experts. A Healthcare Resource Utilization (HRU) form was designed and sent to experts to be filled out independently. Twelve experts were selected through purposeful sampling (one general surgeon, one hepatologist and ten medical oncologists). The answers from the first round were consolidated as averages, and a consensus document was prepared. This document was then discussed in a face-to-face meeting with the experts, and the consensus-building process was finalized. The costs were estimated by using the rules and reimbursement prices of the SSI. Results: The annual cost per patient for unresectable HCC was estimated as 1,056,396 TRY (US$32,937) for the first line treatment and 495,342TRY (US$15,144) for the second line treatment. The annual cost per patient for resectable HCC was estimated as 18,614TRY (US$580). The total cost of HCC to the SSI was estimated as 2,178,840,160 TRY (US$67,933,569) for unresectable cases and 37,082,609TRY (US$1,156,190) for resectable cases. This accounted for 0.4% of total SSI expenditures. Conclusion: Increasing risk factors such as obesity, type 2 diabetes and NAFLD in Türkiye may result in an increase in HCC cases. Our findings indicate the need to consider the potential burden of HCC on the SSI budget in the future.