As part of AP&T's peer-review process, a technical check of this meta-analysis was performed by Prof. G. Eslick.
Meta-analysis: underutilisation and disparities of treatment among patients with hepatocellular carcinoma in the United States
Article first published online: 19 AUG 2013
© 2013 John Wiley & Sons Ltd
Alimentary Pharmacology & Therapeutics
Volume 38, Issue 7, pages 703–712, October 2013
How to Cite
Tan, D., Yopp, A., Beg, M. S., Gopal, P. and Singal, A. G. (2013), Meta-analysis: underutilisation and disparities of treatment among patients with hepatocellular carcinoma in the United States. Alimentary Pharmacology & Therapeutics, 38: 703–712. doi: 10.1111/apt.12450
- Issue published online: 3 SEP 2013
- Article first published online: 19 AUG 2013
- Manuscript Accepted: 21 JUL 2013
- Manuscript Revised: 20 JUL 2013
- Manuscript Revised: 18 JUN 2013
- Manuscript Received: 28 MAY 2013
- Center for Translational Medicine. Grant Number: KL2TR000453
Despite wide availability of treatment options for hepatocellular carcinoma (HCC), several studies have suggested underutilisation in clinical practice.
To quantify utilisation rates for HCC treatment among patients with HCC in the United States, and to summarise patterns of association between utilisation rates and patient socio-demographic characteristics.
We performed a systematic literature review using the Medline database from January 1989 to March 2013. Two investigators independently extracted data on patient populations, study methods and results using standardised forms. Pooled treatment rates for any treatment and curative treatment, with 95% confidence intervals, were calculated. Prespecified subgroup analysis was performed to identify patient-level correlates of treatment utilisation.
We identified 24 studies that met inclusion criteria. The pooled rates of any treatment and curative treatment were 52.8% (95% CI 52.2–53.4%) and 21.8% (95% CI 21.4–22.1%) respectively. Among patients diagnosed at an early stage, the pooled curative treatment rate was 59.0% (95% CI 58.1–59.9%). Elderly, non-Caucasians and patients of low socioeconomic status had lower treatment rates than their counterparts.
Rates of HCC treatment in the United States, including curative treatment rates among patients detected at an early stage, are disappointingly low. Future efforts should focus on identifying appropriate intervention targets to increase treatment rates and reduce socio-demographic disparities.