J. F. Gould1, A. Acher1, P. Schwartz1, C. Stahl1, T. Aiken1, S. Weber1, D. E. Abbott1 1University Of Wisconsin,Division Of Surgical Oncology,Madison, WI, USA
Introduction:
In patients with liver metastases/hepatocellular carcinoma (HCC), portal vein embolization (PVE) and selective internal radiation therapy utilizing Yttrium-90 (Y90) are both used to induce hypertrophy in the future liver remnant (FLR) and increase eligibility for curative intent resection. Little is known however, about the financial burdens of each procedure. We sought to define the total cost of care for patients undergoing PVE and/or Y90 followed by curative intent hepatectomy.
Methods:
A retrospective review of all adult patients undergoing PVE, Y90, and PVE/Y90 with hepatectomy was conducted between 2013-2020. Data for all relevant radiologic and surgical costs for both the index hospitalization and any readmission within 90 days was collected. Clavien Dindo Classification (CD) captured complication severity and Charlson Comorbidity Index (CCI) captured comorbidity burden. Total combined cost for liver directed therapy, surgery, and procedure-related complications was the primary outcome of interest. Fisher’s exact test, Chi-squared, and ANOVA were employed.
Results:
Out of 25 patients, 18 were included in the final analysis; 72% (n=13) were male and the mean age was 59 +/- 14 years. Primary cancers included colon cancer (78%, n=14), cholangiocarcinoma (11%, n=2), and HCC (11%, n=2). Prior to curative intent hepatectomy, 12 patients underwent PVE, 3 underwent Y90 and 3 underwent both PVE and Y90. 61% (n=11) of the patients had a complication following either IR procedure or surgery. The mean cost was $36,254 ± $6,281 (standard deviation) for PVE patients, $83,292 ± 12,562 for Y90 patients and $127,934 ± 12,562 for Y90 + PVE patients. Bivariate analysis demonstrated that type of liver directed therapy, intraoperative blood loss, CCI, CD were associated with a statistically significant increase in cost. Controlling for age, CCI, and estimated blood loss (EBL), multivariate analysis demonstrated that patients who underwent both PVE and Y90 prior to curative intent hepatectomy and those with CD > 4 had a statistically significant increase in cost (Table 1).
Conclusion:
This is the first study to compare the cost of care for patients receiving PVE, Y90, or both followed by curative intent hepatectomy and demonstrated that patients who underwent both PVE and Y90 procedures prior to hepatectomy and those who had severe postoperative complications (CD > 4) had statistically significant higher cost. This study did not demonstrate a cost difference in Y90 versus PVE, however, validation with a larger dataset is needed.
