Inpatient hospital burden of hepatitis C‐diagnosed patients with decompensated cirrhosis

McDonald, Scott; Innes, Hamish; Aspinall, Esther; Hayes, Peter; Alavi, Maryam; Valerio, Heather; Goldberg, David J.; Hutchinson, Sharon J.

doi:10.1111/liv.13681

Cited by 9 publications

(12 citation statements)

References 22 publications

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“…This was based on the occurrence of a pre‐defined set of ICD‐10 (International Classification of Diseases, 10th Revision) codes in either the underlying or contributing cause of death fields (mortality) or either the main or supplementary discharge diagnosis fields (hospital admissions). For DC admissions, the set of ICD codes consisted of ascites (R18), bleeding oesophageal varices (I85.0, I98.3), chronic hepatic failure, including hepatic encephalopathy (K72.1, K72.9), alcoholic hepatic failure (K70.4) and hepatorenal syndrome (K76.7); these ICD codes for defining DC admissions have been used in previous studies . For HCC, the single code was primary liver cancer (C22.0).…”

Section: Methodsmentioning

confidence: 99%

“…For DC admissions, the set of ICD codes consisted of ascites (R18), bleeding oesophageal varices (I85.0, I98.3), chronic hepatic failure, including hepatic encephalopathy (K72.1, K72.9), alcoholic hepatic failure (K70.4) and hepatorenal syndrome (K76.7); these ICD codes for defining DC admissions have been used in previous studies. 16,17 For HCC, the single code was primary liver cancer (C22.0). For liverrelated mortality, the set of DC and HCC codes was augmented by alcoholic liver disease (K70), nonalcoholic liver disease (K71-77),…”

Section: Clinical Outcomesmentioning

confidence: 99%

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Real‐world impact following initiation of interferon‐free hepatitis C regimens on liver‐related outcomes and all‐cause mortality among patients with compensated cirrhosis

McDonald

Pollock

Barclay

et al. 2019

Journal of Viral Hepatitis

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Few studies have investigated clinical outcomes among patients with cirrhosis who were treated with interferon (IFN)‐free direct‐acting antiviral (DAA). We aimed to quantify treatment impact on first decompensated cirrhosis hospital admission, first hepatocellular carcinoma (HCC) admission, liver‐related mortality and all‐cause mortality among a national cohort of cirrhotic patients. Through record linkage between Scotland's HCV Clinical Database and inpatient/day‐case hospitalization and deaths records, a study population comprising chronic HCV‐infected patients with compensated cirrhosis and initiated on IFN‐free DAA between 1 March 2013 and 31 March 2018 was analysed. Cox regression evaluated the association of each clinical outcome with time‐dependent treatment status (on treatment, responder, nonresponder or noncompliant), adjusting for patient factors including Child‐Pugh class. Among the study population (n = 1073) involving 1809 years of follow‐up, 75 (7.0%) died (39 from liver‐related causes), 47 progressed to decompensated cirrhosis, and 28 developed HCC. Compared with nonresponders, treatment response (96% among those attending their 12 weeks post‐treatment SVR test) was associated with a reduced relative risk of decompensated cirrhosis (hazard ratio [HR] = 0.14; 95% CI: 0.05‐0.39), HCC (HR = 0.17; 95% CI: 0.04‐0.79), liver‐related death (HR = 0.13; 95% CI: 0.05‐0.34) and all‐cause mortality (HR = 0.30; 95% CI: 0.12‐0.76). Compared with responders, noncompliant patients had an increased risk of liver‐related (HR = 6.73; 95% CI: 2.99‐15.1) and all‐cause (HR = 5.45; 95% CI: 3.07‐9.68) mortality. For HCV patients with cirrhosis, a treatment response was associated with a lower risk of severe liver complications and improved survival. Our findings suggest additional effort is warranted to address the higher mortality among the minority of cirrhotic patients who do not comply with DAA treatment or associated RNA testing.

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Section: Methodsmentioning

confidence: 99%

Section: Clinical Outcomesmentioning

confidence: 99%

Real‐world impact following initiation of interferon‐free hepatitis C regimens on liver‐related outcomes and all‐cause mortality among patients with compensated cirrhosis

McDonald

Pollock

Barclay

et al. 2019

Journal of Viral Hepatitis

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“…Both nonbleeding and bleeding oesophageal varices episodes were identified via the presence of discharge diagnoses codes (using International Classification of Disease (ICD10); see Table S1) in the same data source. These codes have been used extensively in previous research by ourselves and others . Note that discharge diagnoses are entered for day‐cases as well as for inpatient admissions.…”

Section: Methodsmentioning

confidence: 99%

“…These codes have been used extensively in previous research by ourselves and others. 11,12 Note that discharge diagnoses are entered for day-cases as well as for inpatient admissions. The record-linkage also provided date of death, required for censoring.…”

Section: Study Population and Settingmentioning

confidence: 99%

Uptake of endoscopic screening for gastroesophageal varices and factors associated with variceal bleeding in patients with chronic hepatitis C infection and compensated cirrhosis, 2005‐2016: a national database linkage study

McDonald

Barclay

Hutchinson

et al. 2019

Aliment Pharmacol Ther

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Summary Background Primary measures for preventing morbidity and mortality associated with bleeding gastroesophageal varices in cirrhotic patients include endoscopic screening. Aim To identify factors associated with (a) screening and (b) first hospital admission for variceal bleeding among cirrhotic hepatitis C virus (HCV) patients attending specialist care in Scotland. Methods The Scottish Hepatitis C Clinical Database was linked to national hospitalisation and deaths records to identify all chronic HCV patients diagnosed with compensated cirrhosis in 2005‐2016 (n = 2741). The adjusted odds of being screened by calendar year period were estimated using logistic regression, and the adjusted hazard ratio (HR) of a first variceal bleed using Cox regression. Results About 34% were screened within the period starting 12 months before and ending 12 months after cirrhosis diagnosis. The proportion screened was stable in 2005‐2010 at 42%, declining to 37% in 2011‐2013 and 26% in 2014‐2016. Odds of screening were decreased for age‐groups <40 (OR = 0.61, 95% CI: 0.48‐0.77) and 60+ years (OR = 0.67, 95% CI: 0.48‐0.94), history of antiviral therapy (OR = 0.70, 95% CI: 0.55‐0.89), and cirrhosis diagnosis in 2014‐2015, compared with 2008‐2010 (OR = 0.67, 95% CI: 0.52‐0.86). Compared with 2008‐2010, there was no evidence for an increased/decreased relative risk of a first variceal bleed in any other period, but viral clearance was associated with a lower risk (HR = 0.56, 95% CI: 0.32‐0.97). Conclusions Overall screening uptake following cirrhosis diagnosis was low, and the decline in recent years is of concern. The stable bleeding risk over time may be attributable both to ongoing prevention initiatives and to changing diagnostic procedures creating a patient pool with milder disease in more recent years.

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“…Improving the knowledge of patient characteristics that may influence the hospitalization resource use and inherent costs is therefore a mandatory task in the present worldwide scenario, and may help the decision-makers to manage HCV infection through early treatment or efficient screening practices (e.g., test and treat therapies) and prioritize patients with a potential high need for DAA treatment [2, 11, 33]. In order to assess the historical baseline against which future economic outcomes can be gauged, it is also relevant to examine the distribution of health care costs coming from the pre-DAAs era.…”

Section: Introductionmentioning

confidence: 99%

The inpatient hospital burden of comorbidities in HCV-infected patients: A population-based study in two Italian regions with high HCV endemicity (The BaCH study)

Cammarota¹,

Citarella²,

Guida

et al. 2019

PLoS ONE

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Background & aims Hepatitis C (HCV) is associated with several extrahepatic manifestations, and estimates of the hospitalization burden related to these comorbidities are still limited. The aim of this study is to quantify the hospitalization risk associated with comorbidities in an Italian cohort of HCV-infected patients and to assess which of these comorbidities are associated with high hospitalization resource utilization. Methods Individuals aged 18 years and older with HCV-infection were identified in the Abruzzo’s and Campania’s hospital discharge abstracts during 2011–2014 with 1-year follow-up. Cardio-and cerebrovascular disease, diabetes and renal disease were grouped as HCV-related comorbidities. Negative binomial models were used to compare the hospitalization risk in patients with and without each comorbidity. Logistic regression model was used to identify the characteristics of being in the top 20% of patients with the highest hospitalization costs (high-cost patients). Results 15,985 patients were included; 19.9% had a liver complication and 48.6% had one or more HCV-related comorbidities. During follow-up, 36.0% of patients underwent at least one hospitalization. Liver complications and the presence of two or more HCV-related comorbidities were the major predictors of hospitalization and highest inpatient costs. Among those, patients with cardiovascular disease had the highest risk of hospitalization (Incidence Rate Ratios = 1.42;95%CI:1.33–1.51) and the highest likelihood of becoming high-cost patients (Odd Ratio = 1.37;95%CI:1.20–1.57). Conclusion Beyond advanced liver disease, HCV-related comorbidities (especially cardiovascular disease) are the strongest predictors of high hospitalization rates and costs. Our findings highlight the potential benefit that early identification and treatment of HCV might have on the reduction of hospitalization costs driven by extrahepatic conditions.

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Inpatient hospital burden of hepatitis C‐diagnosed patients with decompensated cirrhosis

Cited by 9 publications

References 22 publications

Real‐world impact following initiation of interferon‐free hepatitis C regimens on liver‐related outcomes and all‐cause mortality among patients with compensated cirrhosis

Real‐world impact following initiation of interferon‐free hepatitis C regimens on liver‐related outcomes and all‐cause mortality among patients with compensated cirrhosis

Uptake of endoscopic screening for gastroesophageal varices and factors associated with variceal bleeding in patients with chronic hepatitis C infection and compensated cirrhosis, 2005‐2016: a national database linkage study

The inpatient hospital burden of comorbidities in HCV-infected patients: A population-based study in two Italian regions with high HCV endemicity (The BaCH study)

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