# Out-of-pocket medical costs in relation to resection of colorectal liver metastases in the Australian healthcare system

## TL;DR

This study examines the out-of-pocket medical costs for patients undergoing liver resection for colorectal liver metastases in Australia and their financial impact.

## Contribution

The study provides new insights into patient-level out-of-pocket costs and financial stress related to liver resection for CRLM in Australia.

## Key findings

- Liver surgical treatment had the highest median out-of-pocket cost of $1011.29.
- Most patients were not worried about out-of-pocket costs and reported no significant financial impact.
- Specialist consultation costs had a median out-of-pocket cost of $393.35.

## Abstract

The cost of treating colorectal liver metastases (CRLM) places a financial burden on the healthcare system; however, there is limited research on the out-of-pocket (OOP) costs to patients. This study aimed to assess the direct medical OOP costs on patients who undergo liver resection for CRLM and evaluate their financial worry, stress, and difficulty.

This was a retrospective cohort analysis of the OOP costs for patients who underwent potentially curative resection of CRLM in Sydney, Australia, between 2010 and June 2021. These costs were determined in Australian dollars from the diagnosis of liver metastases to their last follow-up. Patients completed a series of questions relating to financial worry, stress, and difficulty.

In total, 121 patients underwent liver resection, of which 85 were alive at a median follow-up of 5.3 years (1.8–13.7). There was a 59% response rate (50/85). Specialist consultation costs varied, with a median OOP cost of $393.35. Liver surgical treatment incurred the highest median OOP cost of $1011.29 (range $0–$7246.54). There were minimal OOP costs for chemotherapy and no OOP costs for radiation oncology. Most patients were not worried about the OOP costs (60%) and said there was no impact on their ability to make ends meet (64%) or had no effect on their finances (56%).

This study demonstrates that patients who undergo liver resection for CRLM and have long-term survival have moderate OOP costs. Most patients were not worried or stressed with the amount they had to pay OOP.

The online version contains supplementary material available at 10.1007/s00520-025-09669-2.