Research Article: Cost of illness of hepatocellular carcinoma in Japan: A time trend and future projections

Date Published: June 19, 2018

Publisher: Public Library of Science

Author(s): Kunichika Matsumoto, Yinghui Wu, Takefumi Kitazawa, Shigeru Fujita, Kanako Seto, Tomonori Hasegawa, Isabelle Chemin.


Hepatocellular carcinoma (HCC) is the fifth leading cause of death in Japan. The aim of this study was to calculate the social burden of HCC using the cost of illness (COI) method, and to identify the key factors driving changes in the economic burden of HCC.

Utilizing government-based statistical nationwide data, the cost of illness (COI) method was used to estimate the COI for 1996, 1999, 2002, 2005, 2008, and 2014 to make predictions for 2017, 2020, 2023, 2026, and 2029. The COI comprised direct and indirect costs (morbidity and mortality costs) of HCC.

From 1996 to 2014, COI trended downward. In 2014, COI (579.2 billion JPY) was 0.71 times greater than that in 1996 (816.2 billion JPY). Mortality costs accounted for more than 70% of total COI and were a major contributing factor to the decrease in COI. It was predicted that COI would continue a downward trend until 2029, and that the rate of decline would be similar.

COI of HCC has been decreasing since 1996. Treatment of patients infected with hepatitis C virus using newly introduced technologies has high therapeutic effectiveness, and will affect the future prevalence of HCC. These policies and technologies may accelerate the downward tendency of COI, and the relative economic burden of HCC is likely to continue to decrease.

Partial Text

Hepatocellular carcinoma (HCC; International Disease Classification 10 code C22) is the fifth leading cause of death (the fourth for males and the sixth for females) in Japan [1]. In many patients, HCC is caused by chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection [2–4]. In Japan, it has been reported that 80% of HCC is caused by HBV or HCV [5]. HCC caused by chronic HCV infection is predominant in Japan, whereas HBV infection is the more predominant cause of HCC in other Asian countries [6, 7]. In recent years, the incidence of HCC caused by non-alcoholic steatohepatitis (NASH) has also been on the rise, and has become a social issue [2, 3].

The COI method has been well described as a way to measure the social burden of disease [27–33]. In this study, COI was calculated from 1996 to 2014. Based on these data, future projections were made for the period from 2017 to 2029, to evaluate trends over time. The calculation method used in this study was the same as that used in our previous studies [20, 23].

Table 1 shows the trend of COI and health-related indicators from 1996 to 2014. COI was calculated to be 607.2 billion Japanese yen (JPY) in 2014. The contributions of DCs, MbCs, and MtCs to COI were 131.6 billion JPY, 18.5 billion JPY, and 457.1 billion JPY, respectively. MtCs were the greatest contributors and accounted for 75.3% of total COI. COI decreased continuously from 1996 to 2014 by 1.9% annually, representing a total 0.70-fold decrease. DCs increased until 2002 and decreased gradually thereafter. MbCs decreased from 1999, and MtCs which accounted for more than 70% of COI decreased starting in 2002. The contribution ratio of MtC to total decrease was 106.9%.

The results of this study demonstrated that after peaking in 2002, COI of HCC decreased. This decrease was attributed to decreased MtC. Furthermore, all variable models used herein predicted that COI would continue to trend downward until 2029. The mixed model showed that COI decreased continuously by 2.2% annually from 2014 to 2029, and this pace of decline was similar to that of the past (1.9% annually). The contribution ratio of MtC to total COI decrease was 106.9% in the past trend estimation, and was more than 90% in all three variable models. In fact, the MtC trend was considered to account for the majority of the COI trend.

The findings of the present study suggest that COI of HCC has decreased continuously to date and that this trend is likely to continue at a similar pace. During the study period, average age at death from HCC was older than that from other cancers and a rapid pace of aging was observed. These factors contribute to the decreased social burden of HCC. Moreover, past health policies and technological developments are considered to have accelerated the decrease in COI. We conclude that control policies for HCC are functioning effectively.




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