Clinical outcomes and resource utilisation in Medicare patients with chronic liver disease: a historical cohort study

Abstract

ObjectiveThe aim of this study is to assess recent trends in health resource utilisation and patient outcomes of Medicare beneficiaries with chronic liver disease (CLD).SettingLiver-related mortality is the 10th leading cause of death in the USA, and hepatitis C virus (HCV) and obesity-related non-alcoholic fatty liver disease are the major causes of CLD. As the US population ages and becomes more obese, the impact of CLD is expected to become more prominent for the Medicare population.ParticipantsThis is a retrospective cohort study of Medicare beneficiaries with a diagnosis of CLD based on inpatient (N=21 576; 14 977 unique patients) and outpatient (N=515 990; 244 196 patients) claims from 2005 to 2010.Primary and secondary outcome measuresThe study outcomes included hospital length of stay (LOS) and inpatient mortality as well as inpatient and outpatient inflation-adjusted payments.ResultsBetween 2005 and 2010, there was an annual decrease in LOS of 3.17% for CLD-related hospitalisations. Risk-adjusted in-hospital mortality decreased (OR 0.90, 95% CI 0.87 to 0.94), while short-term postdischarge mortality remained stable (1.00, 0.98 to 1.03). Inpatient per-claim payment increased from $11 769 in 2005 to $12 347 in 2010 (p=0.0006). Similarly, the average yearly payments for outpatient care increased from $366 to $404 (p<0.0001). This change in payment was observed together with a consistent decrease in the proportion of beneficiary-paid amount (25.4–20%, p<0.0001) as opposed to Medicare-paid amount (73.1–80%, p<0.0001). The major predictors of higher outpatient payments were younger age, Asian race or Hispanic ethnicity, living in California, and having more diagnoses and outpatient procedures per claim. The predictors of inpatient spending also included younger age, location and the number of inpatient procedures.ConclusionsLength of inpatient stay and inpatient mortality among Medicare beneficiaries with CLD decreased, while inpatient and outpatient spending increased.

Economic and Quality-of-Life Implications of Non-Alcoholic Fatty Liver Disease

“…There is a remarkable paucity of data addressing economic issues in patients with NAFLD [16,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. Our search identified six articles related to the economics of NAFLD (four for the general population, one in the C65 years old or medically disabled population) (Table 1) [20,23,[30][31][32][33].…”

“…Predictors of cost common for both inpatients and outpatients were younger age and number of procedures. Although non-alcoholic cirrhosis includes a number of diagnostic categories, some of these patients may have had NAFLD [32].…”

“…Our search identified six articles related to the economics of NAFLD (four for the general population, one in the C65 years old or medically disabled population) (Table 1) [20,23,[30][31][32][33].…”

The relationship between a cirrhosis‐specific comorbidity scoring system and healthcare utilization patterns

“…analyzed claims associated with patients with chronic hepatitis C virus (HCV) and found increased risk of higher healthcare costs among patients with ≥2 comorbidities related to HCV (odds ratio: 2.78; 95% CI: 2.48–3.12) or unrelated to HCV (odds ratio: 2.19; 95% CI: 1.76–2.72). A study by Younossi et al . of Medicare beneficiaries with chronic liver disease reported that the number of diagnoses per claim were independent predictors of spending for hospitalization (3.7% payment increase; 95% CI: 3.1–4.3%) and outpatient care (25.5% payment increase; 95% CI: 25.1–25.8%).…”

A prospective, multicentre, observational study of patients with chronic cholestatic liver diseases receiving Udiliv and reg; in India: splendid study

“…10 A recent retrospective survey in United States of America (USA) found that chronic liver disease is associated with a significant increase in medical costs and healthcare resource utilization over time. 11 Pharmacotherapy for cholestasis includes symptomatic treatment of pruritus along with management of complications such as osteopenia and fatsoluble vitamin deficiencies. 1 …”