Increasing Economic Burden in Hospitalized Patients With Cirrhosis: Analysis of a National Database

Abstract

INTRODUCTION: The prevalence of cirrhosis is increasing despite advances in therapeutics, and it remains an expensive medical condition. Studies examining the healthcare burden of inpatient cirrhosis-related care regardless of etiology, stage, or severity are lacking. This study aims to describe the current drivers of cost, length of stay (LOS), and mortality in hospitalized patients with cirrhosis. METHODS: Using the National Inpatient Sample (NIS) data from 2008 to 2014, we categorized admissions into decompensated cirrhosis (DC), compensated cirrhosis (CC), and NIS without cirrhosis. Descriptive statistics and regression analysis were used to analyze the association between patient characteristics, comorbidities, complications, and procedures with costs, LOS, and mortality in each group. RESULTS: The hospitalization costs for patients with cirrhosis increased 30.2% from 2008 to 2014 to $7.37 billion. Cirrhosis admissions increased by 36% and 24% in the DC and CC groups, respectively, compared with 7.7% decrease in the NIS without cirrhosis group. DC admissions contributed to 58.6% of total cirrhotic admissions by 2014. Procedures increased costs in both DC and CC groups by 15%–152%, with mechanical ventilation being associated with high cost increase and mortality increase. Complications are also key drivers of costs and LOS, with renal and infectious complications being associated with the highest increases in the DC group and infections and nonportal hypertensive gastrointestinal bleeding for the CC group. DISCUSSION: Economic burden of hospitalized patients with cirrhosis is increasing with more admissions and longer LOS in DC and CC groups. Important drivers include procedures and portal hypertensive and nonportal hypertensive complications.

ICD-10-AM codes for cirrhosis and related complications: key performance considerations for population and healthcare studies

“…Accurate coding of these is crucial to track patient outcomes, healthcare burden and economic impact of cirrhosis. 10 Similar to findings in VA data, 5 we found that ICD-10-AM codes for ascites, gastrooesophageal varices and HCC were relatively accurate. We also found the probability that patients without these codes didn't have these complications was very high for HCC (97.9%), but substantially lower for ascites (75.8%) and varices (75.5%).…”

In-Hospital Outcomes of Patients with Acute Decompensated Heart Failure and Cirrhosis: An Analysis of the National Inpatient Sample

“…HF is a growing public health problem due to increasing mortality rates and rising health care costs due to comorbidities like cirrhosis that require prolonged hospitalization and treatment with diuretics [ 7 , 8 ]. The common underlying pathophysiological mechanisms of ADHF and cirrhosis may explain why our patient cohort had a higher rate of mortality and a longer hospital LOS [ 9 – 11 ]. At the beginning of the disease cycle, patients with HF have a lowered cardiac output, whereas patients with cirrhosis undergo systemic arterial vasodilation that increases cardiac output.…”

Burden of pulmonary hypertension in patients with portal hypertension in the United States: a retrospective database study

“… 18 , 19 This likely reflects that the patients in our study’s control group had portal hypertension, which is itself associated with higher HCRU and costs. 20 – 22 …”