The Cost of Dying of End-Stage Liver Disease

Wong, Linda L.; McFall, Paul; Wong, Livingston

doi:10.1001/archinte.1997.00440340047004

Cited by 44 publications

(17 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For example, in this analysis, liver transplantation cost $108659 for the first year and $18976 per year subsequently (in 1999 dollars), but other studies that used charge data reported transplantation costs of $200 000 or higher for the surgery and $25000 per year for medications. 57,58 In addition to direct medical costs, our analysis suggested that the societal burden of indirect or time costs 59 related to premature mortality or disability from decompensated cirrhosis or hepatocellular carcinoma may add another $54.2 and $21.3 billion, respectively, in lost productivity, both of which exceed the $10.3 billion baseline direct medical costs of hepatitis C.…”

Section: Discussionmentioning

confidence: 90%

Estimating future hepatitis C morbidity, mortality, and costs in the United States

Wong

McQuillan²,

McHutchison³

et al. 2000

Am J Public Health

491

View full text Add to dashboard Cite

OBJECTIVES: This study estimated future morbidity, mortality, and costs resulting from hepatitis C virus (HCV). METHODS: We used a computer cohort simulation of the natural history of HCV in the US population. RESULTS: From the year 2010 through 2019, our model projected 165,900 deaths from chronic liver disease, 27,200 deaths from hepatocellular carcinoma, and $10.7 billion in direct medical expenditures for HCV. During this period, HCV may lead to 720,700 years of decompensated cirrhosis and hepatocellular carcinoma and to the loss of 1.83 million years of life in those younger than 65 at a societal cost of $21.3 and $54.2 billion, respectively. In sensitivity analysis, these estimates depended on (1) whether patients with HCV and normal transaminase levels develop progressive liver disease, (2) the extent of alcohol ingestion, and (3) the likelihood of dying from other causes related to the route of HCV acquisition. CONCLUSIONS: Our results confirm prior Centers for Disease Control and Prevention projections and suggest that HCV may lead to a substantial health and economic burden over the next 10 to 20 years.

show abstract

Section: Discussionmentioning

confidence: 90%

Estimating future hepatitis C morbidity, mortality, and costs in the United States

Wong

McQuillan²,

McHutchison³

et al. 2000

Am J Public Health

491

View full text Add to dashboard Cite

show abstract

“…This is particularly relevant in cirrhotic patients, owing to the exponential increase in the incidence of this condition and the limited ICU resources (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) Our study assessed, to our knowledge for the first time, the accuracy of prognostic scores in cirrhotic patients admitted to a GICU. In our series, all the tested scores displayed good discrimination and calibration.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, a significant percentage (36.7%) of the total cost of ICU care for cirrhotic patients is spent on those who do not survive (11,16,19). Additionally, it must be borne in mind that ICUs are a very limited health resource (10,11,18).…”

Section: Introductionmentioning

confidence: 99%

“…The incidence of liver cirrhosis is increasing exponentially and cirrhotic patients admitted to ICUs have high mortality rates and a high rate of consumption of resources (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Furthermore, a significant percentage (36.7%) of the total cost of ICU care for cirrhotic patients is spent on those who do not survive (11,16,19).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prognostic scores in cirrhotic patients admitted to a gastroenterology intensive care unit

Freire

Romãozinho²,

Amaro³

et al. 2011

Rev. esp. enferm. dig.

View full text Add to dashboard Cite

Aim: to assess the prognostic accuracy of Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II, Sequential Organ Failure Assessment (SOFA), Model for End-stage Liver Disease (MELD) and ChildPugh-Turcotte (CPT) in predicting GICU mortality in cirrhotic patients.Methods: the study involved 124 consecutive cirrhotic admissions to a GICU. Clinical data, prognostic scores and mortality were recorded. Discrimination was evaluated with area under receiver operating characteristic curves (AUC). Calibration was assessed with Hosmer-Lemeshow goodness-of-fit test.Results: GICU mortality was 9.7%. Mean APACHE II, SAPS II, SOFA, MELD and CPT scores for survivors (13.6, 25.4, 3.5, 18.0 and 8.6, respectively) were found to be significantly lower than those of non-survivors (22.0, 47.5, 10.1, 30.7 and 12.5, respectively) (p < 0.001). All the prognostic systems showed good discrimination, with AUC = 0.860, 0.911, 0.868, 0.897 and 0.914 for APACHE II, SAPS II, SOFA, MELD and CPT, respectively. Similarly, APACHE II, SAPS II, SOFA, MELD and CPT scores achieved good calibration, with p = 0.146, 0.120, 0.686, 0.267 and 0.120, respectively. The overall correctness of prediction was 81.9%, 86.1%, 93.3%, 90.7% and 87.7% for the APA-CHE II, SAPS II, SOFA, MELD and CPT scores, respectively.Conclusions: in cirrhotics admitted to a GICU, all the tested scores have good prognostic accuracy, with SOFA and MELD showing the greatest overall correctness of prediction. INTRODUCTIONPrognostic models are used for comparison and quality assessment of different Intensive Care Units (ICUs) and within the same ICU over time, for audit and clinical research, for evaluating therapeutic effectiveness and for guiding discussions between clinicians and families (1-6).The incidence of liver cirrhosis is increasing exponentially and cirrhotic patients admitted to ICUs have high mortality rates and a high rate of consumption of resources (7-18). Furthermore, a significant percentage (36.7%) of the total cost of ICU care for cirrhotic patients is spent on those who do not survive (11,16,19). Additionally, it must be borne in mind that ICUs are a very limited health resource (10,11,18). Thus, predictive models could be very important decision-making tools in this setting.Two types of prognostic scores can be used in cirrhotics admitted to ICUs: general prognostic models and disease-specific models. The general prognostic models include two main categories: firstly, those evaluating severity of illness, namely the Acute Physiology and Chronic Health Evaluation (APACHE) II (20) and Simplified Acute Physiology Score (SAPS) II (21); secondly, models quantifying organ dysfunction and failure, of which the most widely-used is the Sequential Organ Failure Assessment (SOFA) (22,23 Vol. 103. N.° 4, pp. 177-183, 2011 Received: 04-10-10. Accepted: 02-12-10.

show abstract

“…[28][29][30] For infected individuals who either fail treatment or go untreated, the suffering and cost of end-stage liver disease can be enormous. 31 …”

Section: Discussionmentioning

confidence: 99%

Hepatitis B vaccination practices in state and federal prisons

Charuvastra¹,

Stein²,

Schwartzapfel³

et al. 2001

Public Health Reports

View full text Add to dashboard Cite

Objective. Incarcerated populations are a group at high risk for hepatitis B. About 30% of people experiencing acute hepatitis B virus infection (HBV) have a history of incarceration. Offering routine HBV vaccinations to incarcerated individuals could have a significant effect on public health. The objective of this study is to identify current vaccine practices and the perceived feasibility of routine vaccinations for hepatitis B within correctional settings.Method. The authors surveyed the medical directors of state correctional facilities in all 50 states and the federal prison system regarding current HBV vaccine practices. Surveys were faxed or mailed between July 1 and September 1, 2000.Results. Thirty-five states and the federal system responded (response rate = 70.6%). These systems account for 77% of all inmates in federal or state prisons and jails. Two states give hepatitis B vaccine routinely, nine states offer no hepatitis B vaccine, and 26 states and the Federal Bureau of Prisons offer hepatitis vaccine to some inmates. Most states do not spend enough money to vaccinate even those prisoners at highest risk. Under the Vaccine for Children program, 19,520 youths could receive vaccine immediately. According to the respondents, if vaccine were available at no-cost, 25 states and the Federal Bureau of Prisons would routinely offer vaccination to all inmates.Conclusions. Most correctional systems do not routinely offer vaccine to their incarcerated populations, but would if funds were available. There exists now a unique public health opportunity to prevent a significant proportion of new hepatitis B infections.

show abstract

The Cost of Dying of End-Stage Liver Disease

Abstract: It is difficult to estimate the total cost of ESLD; however, in evaluating inpatient costs, we see that it is expensive and significant amounts are spent on patients who die. Further study is necessary to determine which factors can optimize the cost of ESLD.

Cited by 44 publications

References 3 publications

Estimating future hepatitis C morbidity, mortality, and costs in the United States

Estimating future hepatitis C morbidity, mortality, and costs in the United States

Prognostic scores in cirrhotic patients admitted to a gastroenterology intensive care unit

Hepatitis B vaccination practices in state and federal prisons

Contact Info

Product

Resources

About