Adhering to the Barcelona Clinic Liver Cancer Disease Staging and Treatment Algorithm: Disease Burden and Cost of Illness of Hepatocellular Carcinoma in Portugal.

Objectives: The aim of this study was to assess disease burden and cost of illness of hepatocellular carcinoma (HCC) in Portugal, assuming full adherence to the treatment algorithm associated to the Barcelona Clinic Liver Cancer (BCLC) system. Methods: An individual-level, continuous-time, state-transition model was used to simulate the progression of HCC patients through the BCLC disease stages. Health state transition rates were derived from the published literature. An expert panel provided further information on Portuguese epidemiology and clinical practice, including treatments and other healthcare resources utilization at each disease stage. Unit costs for health resources were collected from national public sources. HCC associated costs and outcomes were estimated over a 5-year time horizon. Results: Over the 5-year horizon of this study, the projections of HCC annual prevalence (including patients in remission) show an increasing trend, rising from 4,151 in 2023 to 4,851 in 2027. Despite the slight reduction in the predicted annual mortality rate (from 29.8% to 28.7%), we estimated that HCC could still lead to a total of 120,314 years of life lost due to premature mortality in the Portuguese population. Costs attributed to HCC were predicted to rise from around EUR 70 million in 2023 up to around EUR 77 million in 2027. Around 44.3% of these costs are related to HCC systemic treatment and 29.0% related to liver transplantation costs. Conclusion: HCC's increasing prevalence trend will continue to impose substantial disease burden in terms of premature mortality, with more than 20,000 years of life lost per year in the Portuguese population. Consequently, costs attributed to HCC are expected to rise despite the reduction on mortality by full adherence to the BCLC treatment algorithm. Continuing high disease burden and substantial cost of illness urge for a need of a comprehensive and effective healthcare interventions, as well as adequate resource allocation for HCC.