Health-Related Quality of Life and Economic Burden of People Living with Liver Cancer in Ghana

Abstract

Introduction: Liver cancer is a leading cause of cancer-related mortality in Ghana, with a rising incidence that imposes significant clinical, economic, and humanistic burdens. The disease often presents at advanced stages, leading to poor prognosis and substantial healthcare costs, borne out-of-pocket. Concurrently, it severely impairs patients' health-related quality of life (HRQoL). However, comprehensive data on the economic burden and HRQoL of liver cancer patients in Ghana are limited. This study assessed the economic burden and HRQoL outcomes among persons living with liver cancer in selected teaching hospitals in Ghana. Methods: A cross-sectional, prevalence-based cost-of-illness survey was conducted between April and July 2025. Data were collected from 121 liver cancer patients attending oncology clinics at Korle-Bu, Cape Coast, and Tamale Teaching Hospitals using structured questionnaires. Direct costs (medical and non-medical) and indirect costs (productivity losses) were estimated. HRQoL was measured using the EQ-5D-5L instrument and the EQ-VAS. Data were analyzed using descriptive statistics. Results: The mean age of respondents was 48.8 years (SD = 12.2), with the majority being male (56.2%). The average monthly cost per patient was GHS 5,441.29 (US$529.91). Direct costs constituted 98.1% of the total economic cost, dominated by medical expenses such as imaging, laboratory tests, and medications. Indirect costs accounted for 1.9% of the total economic cost. HRQoL was markedly impaired, with 97.5% of patients reporting anxiety/depression and 83.5% reporting pain/discomfort. Mean EQ-5D utility scores were low (ranging from 0.48 to 0.62 across age groups), and scores declined significantly with advanced cancer stages (Stage 3 median EQ-5D = 0.12; EQ-VAS = 25). Conclusion: Liver cancer imposes a substantial dual burden of high economic costs and significantly impaired HRQoL on patients in Ghana. The findings underscore the need for policy reforms to expand health insurance coverage for cancer care, strengthen early detection and prevention programs, decentralize oncology services, and integrate psychosocial and palliative support into standard care to mitigate the economic and quality-of-life impacts of the disease.