Productivity loss by cancer stage in patients newly diagnosed with hepatocellular carcinoma

Abstract

Background: New cancer diagnosis is associated with employment decrease, workplace absenteeism, and attributable costs to employers. To date, no studies have summarized the productivity loss experienced by patients newly diagnosed with hepatocellular carcinoma (HCC) by disease stage. Objective: The objective of this study was to estimate the workplace productivity loss in the year following diagnosis among patients newly diagnosed with early, intermediate, and advanced HCC in a commercially insured US population. Methods: We conducted a retrospective cohort study using commercial claims from the Merative® Marketscan® database to identify incident diagnoses of primary HCC between January 1, 2010, and December 31, 2020. Patients with primary HCC were stratified into early-, intermediate-, or advanced-stage cohorts based on the presence of secondary malignancy codes, or first treatment received after index diagnosis. The mean workdays lost and cost attributable to workdays lost in the year following a new diagnosis were calculated using the Kaplan-Meier sample averages (KMSA) to account for censoring in each cohort. An exploratory analysis was conducted on two subgroups in the early and advanced cohorts to assess productivity loss in patients with and without treatment. Results: Mean workdays lost in the year following a new HCC diagnosis among the early, intermediate, and advanced cohorts was 22.6 days (95% CI: 16.0, 29.8), 17.4 days (95% CI: 11.9, 23.2), and 19.5 days (95% CI: 15.6, 23.6), respectively. Corresponding indirect costs were $6,031(95% CI: 4,270, 7,953), $4,644 (95% CI: 3,176, 6,192), and $5,204 (95% CI: 4,163, 6,298) in the early, intermediate, and advanced cohorts. Early-stage patients without a liver transplant and advanced-stage patients who received systemic therapy had 19.7 (95% CI: 12.7, 27.4) and 22.0 (95% CI: 16.6, 27.7) mean annual workdays lost, respectively. Conclusion: Productivity loss varies by stage and appears to be higher in early-stage patients who receive more intensive treatments in the first 12 months following a new HCC diagnosis. Further research to explore productivity loss by type of treatment received within patients of the same cancer stage is necessary to understand the impact of treatment on workplace productivity loss in patients newly diagnosed with HCC.