Economic burden of recurrence in patients with hepatocellular carcinoma after curative-intent treatment in Spain

BACKGROUND: Despite potentially curative-intent treatments such as resection, ablation, or liver transplantation, a significant proportion of patients with hepatocellular carcinoma (HCC) experience recurrence. This study aims to quantify the economic burden of HCC recurrence in patients initially diagnosed with a BCLC-0 or BCLC-A tumor, who received curative-intent treatment and achieved an initial radiological complete response. METHODS: A decision-tree model was developed to simulate the management of HCC recurrence over a 1-year time horizon. As a secondary analysis, the time horizon was extended to 5 years to capture the cost of a potential second recurrence. Clinical parameters included HCC stage (0, A, B, C, and D, per Barcelona Clinic Liver Cancer [BCLC] staging), treatment modalities, adverse events and routine follow-up, were provided by a multidisciplinary panel of experts. The analysis was conducted from the Spanish National Health System perspective, considering only direct medical costs (expressed in 2025 euros). Deterministic sensitivity analyses were performed to assess the robustness of the base case results. RESULTS: The target population was estimated to be 1,250 patients with HCC recurrence after curative-intent treatment of the first HCC in Spain. The total cost of managing these 1,250 recurrences over one year was estimated at €33 million, with an average cost per recurrence of €26,426. When the time horizon was extended to 5 years, the total cost increased to €43.3 million (+€10.3 million), primarily due to 228 additional recurrences. The average cost per recurrence over 5 years rose to €34,637, and a hypothetical patient experiencing two recurrences over this period would cost €59,542. Sensitivity analyses confirmed the robustness of these results. CONCLUSIONS: The literature on the economic burden of HCC is scarce. This study is the first to estimate the cost of HCC recurrence after curative-intent treatment in Spain. Further research is needed to better understand the full economic impact of this complex disease.