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COST ASSESSMENT AND OUTCOME TRENDS FOR TREATMENT OF CANCER OF LIVER AND INTRAHEPATIC BILE DUCTS
Young K. Hong^*, Jasmit Shah, Woihwan Kim, Robert C. Martin
Surgery, University of Louisville, Louisville, KY
Background:
There is a rising demand to increase cost-effectiveness given the current healthcare spending in the US. Treatment of hepatobiliary malignancies requires a multidisciplinary approach with variability among different hospitals over the years. We analyzed the healthcare spending for patients treated at US hospitals for the cancer of the liver and intrahepatic bile duct to determine their impact on clinical outcome.

Method:
We utilized the National Inpatient Sample (NIS) database for years 2007 to 2013 and analyzed the various trends in adjusted hospital charges per year nationally, by regionalized hospitals systems, an average length of stay, mortality, and by racial demographics.

Results:
The average inflation adjusted cost per year of treatment pre-2009 vs post-2009 were (,091.07 +/- 81,044.23 vs ,173.16 +/- 105,514.53; p = 0.07). While the average length of stay was similar with 6.58 days in pre-2009 vs 6.32 days post-2009, there was a decrease in the 30-day mortality rate from 11.91% vs. 9.74% (p=0.007). The regional geographic spending patterns for 2012-2013 demonstrated highest average charges within Pacific and Mid-Atlantic regions compared to East South Central and South Atlantic (,840.73 vs ,067.43; p < 0.001). While there has been an increase trend in the number of White (56.3% vs. 58.5%; p = 0.01) and Black patients (13.2% vs 15.05%; p = 0.01) being treated, there has been a decrease in Asian/Pacific Islander patients treated 11.57% vs 8.38% (p = 0.005).

Conclusion:
There were an increase hospital charges for cancer of the liver and intrahepatic bile duct post-2009 but lower 30-day mortality and similar length of stay. High variation in hospital charges exists by regional hospital systems with highest in the Pacific and Mid-Atlantic group and lowest in the South Atlantic and East South Central hospitals. Finally, there was an increase in a number of Black patients while a decrease of Asian/Pacific Islander patients being treated during this time period. Future analysis will need to be performed to determine the etiology of this disparity trend.

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