Trends in Alcoholic Hepatitis-related Hospitalizations, Financial Burden, and Mortality in the United States

Abstract

Background Alcoholic hepatitis (AH) is the most florid manifestation of alcoholic liver disease which accounts for significant morbidity, mortality and financial burden. Aim of this study is to evaluate temporal trend of hospitalizations from alcoholic hepatitis and evaluate its financial impact. Methods The National Inpatient Sample (NIS) databases (from 2002 to 2010) which are collected as part of Healthcare Cost and Utilization Project by Agency for Healthcare Research and Quality were utilized. Individuals with age ≥ 21 years were included. The hospitalizations with primary diagnosis of AH were captured by ICD-9 codes. The national estimates of hospitalization were derived using sample weights provided by NIS. Simple linear regression method was used to assess trends in mortality and length of stay over time. Results We observed the increased in total cases of AH-related hospitalization from 249,884 (0.66% of total admission in 2002) to 326,403 (0.83% of total admission in 2010). The significant increase in the total admission rate was attributable mainly to the rise in inpatient hospitalization for secondary diagnosis of AH (0.48% in 2002 to 0.67% in 2010). Most of the AH related hospitalization were males. Hepatic encephalopathy was found to be the most common admitting diagnosis for individuals hospitalized with secondary diagnosis of AH (8.9% in 2002 and 8.6% in 2010). There was a significant decrease in inpatient mortality for primary diagnosis of AH from 10.07 % (in 2002) to 5.76% (in 2010) (absolute risk reduction: 4.3%). Average cost of hospitalization related to primary diagnosis of AH was $27,124 and $46,264 in 2002 and 2010, respectively. After adjusting for inflation, the additional cost of each hospitalization seemed to increase by 40.7% in 2010 compared to 2002 (additional cost per hospitalization $11,044 in 2010 compared to 2002). Federal (Medicare) or state (Medicaid) supported health insurance program are the main primary expected payers for these AH hospitalizations (~25% – 29%). Despite increase in cost per hospitalization, length of stay for hospitalization due to primary diagnosis of AH was not observed to decrease substantially over time (6.7 days in 2002 to 6.1 days in 2010). Conclusion AH-related hospitalization continued to increase during the study period, despite the decreasing in the in-hospital mortality rate. Substantial increases in healthcare cost and utilization among hospitalized AH patients were observed.

Alcoholic Liver Disease in Asia, Europe, and North America

“…Of these, 119 subjects (7.4%) had acute AH and 179 subjects (11%) had AH with cirrhosis 35 . In the US, total cases of AH-related hospitalization increased from 249,884 (0.66% of total admissions) in 2002 to 326,403 (0.83% of total admissions) in 2010, based on analysis of National Inpatient Sample data 36 . AH was found in ~29% of hospitalized patients with ALD in India 37 .…”

“…In most of the studies from the US and Europe, the mean age of patients at the time of diagnosis with ALD has been 45–55 years old 36, 35, 43, 44 . Data from the US using the National Hospital Discharge Survey 2010 and National Inpatient Sample showed that most patients with a diagnosis of ALD were 45–64 years old, 45 with the average age of 53 years 36 .…”

“…Data from the US using the National Hospital Discharge Survey 2010 and National Inpatient Sample showed that most patients with a diagnosis of ALD were 45–64 years old, 45 with the average age of 53 years 36 . The age of diagnosis of patients with ALD in the US is similar to that from several countries in Europe 35, 43, 44 .…”

Model for end-stage liver disease-Na score or Maddrey discrimination function index, which score is best?

“…The true prevalence is unknown, but histologic studies of patients with ALD suggest that AH may be present in as many as 10%-35% of hospitalized alcoholic patients [30,31] . Although a recent publication reported that the inpatient mortality rate in AH has decreased in the United States (from 10.07% in 2002 to 5.76% in 2010), in this cohort of Mexican patients with AH we found a high mortality rate, 44% at 30 d and 57.6% at 90 d [32] . Our results are similar to that reported in a recent multicentric study in Mexico in 175 patients with AH, where overall and 90-d mortality rate were 36% and 51%, respectively [3] .…”

Challenges in Patient Enrollment and Retention in Clinical Studies for Alcoholic Hepatitis: Experience of the TREAT Consortium

“…When severe, as judged by the MELD over 19 or Maddrey discriminant function over 32, mortality approaches 50% within the first 30–90 days; those surviving the acute phase still carry a high risk of dying in the ensuing year (Mathurin and Bataller, 2015). Analysis of hospital and insurance administrative data suggests that the incidence of (AH) is rising (Jinjuvadia and Liangpunsakul, 2015). The only widely used therapy, corticosteroids, is at best modestly effective and has significant contra-indications and side effects.…”