Costs and health outcomes of liver transplantation for hepatocellular carcinoma: a scoping review

BACKGROUND: Hepatocellular carcinoma (HCC) is the most common primary liver cancer, accounting for 70-90% of all cases. Liver transplantation has demonstrated superior survival rates compared to surgery; however, there is a significant knowledge gap regarding the costs and outcomes across different healthcare settings and patient populations. This scoping review aimed to map the literature on the costs associated with hepatocellular carcinoma (HCC) and liver transplantation in patients with hepatocellular carcinoma (HCC). METHODS: We conducted a scoping review of studies published between 2019 and 2024 using PubMed, Embase, Scopus, LILACS, and Google Scholar. Data extraction focused on study characteristics, economic perspective, time horizon, discounting practices, cost components, data sources, and reported clinical outcomes. A qualitative descriptive synthesis was performed to characterize methodological approaches used to assess costs and outcomes. RESULTS: Fifteen studies were included, including 8 cost analyses and 7 cost-effectiveness studies. Study perspective was explicitly reported in 8 studies (53.3%), including 5 from the health system perspective and 3 from the payer perspective. Time horizons ranged from 3 years to lifetime. Among economic evaluations that reported discounting, annual discount rates ranged from 3% to 5%. Direct costs were assessed in 9 studies (60.0%), and institutional or hospital-based data sources were the most commonly used. CONCLUSION: The included studies showed substantial methodological variation in perspective, time horizon, costing approach, and outcome definitions, which limited cross-study comparability. More standardized economic reporting is needed to strengthen future evidence on liver transplantation for HCC and support resource allocation decisions.