[version 1; peer review: 1 approved]
No competing interests were disclosed.
Hepatocellular carcinoma (HCC) is the most common primary liver cancer, accounting for 70–80% of cases. Liver transplantation has demonstrated superior survival rates compared to surgery; however, there is a significant knowledge gap regarding costs and outcomes across different healthcare settings and populations.
This scoping review aimed to map the literature describing the costs associated with hepatocellular carcinoma (HCC) and liver transplantation in patients with hepatocellular carcinoma (HCC).
This review will search for studies published between 2019 and 2024 in the PubMed, Embase, Scopus, LILACS, and Google Scholar databases. Data extraction included the study characteristics, cost variables, clinical outcomes, and methodology. A qualitative analysis of the papers will identify and describe the different methods used to assess the costs and clinical outcomes.
This review provides a summary of the literature related to the cost estimation and clinical outcomes of HCC and liver transplantation.
Hepatocellular carcinoma (HCC), also known as hepatocarcinoma, is the most common type of primary liver cancer, accounting for 70-80% of all cases.
Among the most significant risk factors associated with the rising incidence of HCC, hepatitis B carriers have a 10–25% lifetime risk of developing HCC.
Curative treatment for HCC is based on surgical resection or liver transplantation, and diagnosis is made at an early stage of the disease. However, most patients with HCC present with advanced disease and underlying liver dysfunction, limiting their curative options. In such cases, surgery is feasible in only approximately 15% of HCC patients, and the 5-year survival rate after potentially curative resection ranges from 33% to 50%.
Oncological research has primarily focused on the outcomes associated with pharmacological treatment and radiotherapy. This trend has created significant knowledge gaps, particularly regarding resource utilization, associated costs, and treatment outcomes in terms of survival within the context of routine clinical practice in middle- and low-income countries. In these settings, the technology available for managing HCC may differ significantly from that used in high-income countries, making it necessary to describe the variables and resources included in the cost estimation and cost-of-illness analyses.
Given the high heterogeneity present in cost studies related to liver transplantation in patients with HCC, this scoping review aims to identify the different methods used in cost estimation, the variables of interest considered, and the outcomes associated with this procedure across various contexts and populations. This scoping review provides a summary of the literature related to cost estimation, the structural characteristics measured, the selection of clinical outcome criteria studied, and the current landscape of HCC costs and liver transplantation in HCC patients. Additionally, it will serve as a foundation for future systematic reviews and inform primary research on the development of cost-estimation models and cost-effectiveness analyses in this context.
The objective of this scoping review was to map the literature describing the costs associated with HCC and liver transplantation in patients with HCC, specifically, to describe the methodologies used to estimate the cost of liver transplantation for HCC, characterize the clinical population investigated in the studies, and provide an overview of the factors or variables used in cost estimation models and outcomes. For the purposes of this scoping review, cost studies are defined as studies that analyze the costs of healthcare interventions, including cost descriptions, cost-of-illness studies (economic burden of the disease),
The guiding question for this scoping review is as follows: What are the methodologies used in cost estimation, clinical characteristics, and health outcomes measured in patients with hepatocellular carcinoma and liver transplantation for hepatocellular carcinoma?
Population: Patients with hepatocellular carcinoma (HCC) and patients with HCC who underwent liver transplantation. Concept: Methodologies used in cost estimation, variables included in the analysis, clinical characteristics, and measured health outcomes.
This review focuses on the methodologies used in cost measurement, as well as the variables of interest employed in both cost and outcome estimations. Additionally, the context (healthcare settings, such as high-, middle-, and low-income countries) and population (different patient populations, such as those with various stages of HCC, underlying liver disease, and comorbidities) will be considered.
A search will be conducted in bibliographic databases, such as PubMed, Scopus, Embase, LILACS, and Google Scholar. Relevant search terms for HCC, transplantation costs, and clinical outcomes were also used. The search will be complemented by manual searches (snowballing) in specialized journals and by reviewing the references of the selected studies. The search period covered information from 2019 to June 06, 2024.
Studies were selected based on the following inclusion criteria:
Patients with hepatocellular carcinoma (HCC). Liver transplantation for hepatocellular carcinoma. Costs and clinical outcomes associated with HCC and liver transplantation for HCC. Original articles only (abstracts, conference summaries, posters, reviews, letters, editorials, and books were excluded). Publications in indexed journals. There were no language or regional restrictions. Population aged ≥ 18 years.
Studies will be independently selected by two reviewers. In cases of disagreement, a third reviewer was consulted.
The following data were extracted from the selected studies
Countries. Context (hospital, outpatient, surgery). Analyzed population (population characteristics). Study perspective (Health System, Ministry of Health, Insurer, Service Provider, etc.). Cost and clinical variables of the study. Time horizon and discounting. Compared interventions. Methods for evaluating cost outcomes. Methods for evaluating effectiveness and utility outcomes. Modeling or calculation of the analysis. Economic and health outcomes (mean cost, years of life gained, and number of deaths avoided). Uncertainty (e.g., deterministic and probabilistic sensitivity analyses, scenarios, and subgroup analyses).
Data were independently extracted by two reviewers. In case of disagreement, a third reviewer will be consulted.
The data were analyzed qualitatively. Various methods used to evaluate the costs and clinical outcomes associated with hepatocellular carcinoma will be identified and described. Since our approach is broad and aims to describe and map the available evidence, the risk of bias in the studies will not be a criterion for excluding the identified articles. In scoping reviews, it is common to omit this aspect because the primary objective of a scoping review is to describe and map a body of literature in terms of characteristics and factors detailed by the review's objectives, questions, and inclusion criteria.
Our search excluded preprint studies available in databases such as medRxiv/bioRxiv or conference abstracts. We opted to exclude the latter because it is unlikely that they would provide all the necessary information to accurately complete the proforma. We restricted our search to PubMed, Scopus, Embase, and LILACS, which are four online databases likely to include the most significant published works in this area. Studies from the NHS EED database were only updated until 2015 and, therefore, will not be included in the search.
This research was approved by the Ethics Committee of the Hospital San Vicente Fundación Rionegro, minutes 11-2023 from April 2023. However, it is essential to clarify that, as this is a scoping review of the literature, this study does not directly involve human subjects. Therefore, according to Colombian Law 8430 of 1993, this study is classified as risk-free research. The findings of this scoping review will be disseminated through peer-reviewed publications and conference presentations.
This study did not require patient consent to participate.
No data are associated with this article.
This project contains the following underlying data:
Data are available under the terms of the
Ministry of Science, Technology and Innovation of Colombia for funding the project. Hospital San Vicente Fundación Rionegro for allowing the project's execution at the hospital. Hospital Universitario Mayor Méderi for the support in publishing the study protocol.
These authors present a protocol to conduct a review of the literature describing costs associated with HCC and the cost of OLT in HCC, with a focus on middle to low income countries. The proposed protocol provides a thorough explanation of the methods and the search strategy that is appropriate for the question posed. The rational behind the study is reasonable and will provide valuable insight to this field. No date was presented to review.
Is the study design appropriate for the research question?
Yes
Is the rationale for, and objectives of, the study clearly described?
Yes
Are sufficient details of the methods provided to allow replication by others?
Yes
Are the datasets clearly presented in a useable and accessible format?
Not applicable
Reviewer Expertise:
General surgery and outcomes, Surgical oncology
I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.