Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jul;10(7):e00062.
doi: 10.14309/ctg.0000000000000062.

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

Archita P Desai  1 , Prashanthinie Mohan  2 , Brandon Nokes  3 , Deekksha Sheth  4 , Shannon Knapp  5 , Malaz Boustani  6 , Naga Chalasani  1 , Michael B Fallon  7 , Elizabeth A Calhoun  2
Affiliations

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

Archita P Desai et al. Clin Transl Gastroenterol. 2019 Jul.

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.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Primary diagnosis for admission by group reveals distinct reasons for admission between those with (a) decompensated cirrhosis, and (b) compensated cirrhosis. Analysis done on admissions from 2008 to 2011 on primary diagnosis codes with prevalence of ≥0.1%.
See this image and copyright information in PMC

References

    1. Tapper EB, Parikh ND. Mortality due to cirrhosis and liver cancer in the United States, 1999–2016: observational study. BMJ 2018;362:k2817. - PMC - PubMed
    1. Murray CJ, Atkinson C, Bhalla K, et al. The state of US health, 1990–2010: Burden of diseases, injuries, and risk factors. JAMA 2013;310(6):591–608. - PMC - PubMed
    1. Peery AF, Crockett SD, Barritt AS, et al. Burden of gastrointestinal, liver, and pancreatic diseases in the United States. Gastroenterology 2015;149(7):1731–41.e3. - PMC - PubMed
    1. Kim D, Li AA, Perumpail BJ, et al. Changing trends in etiology- and ethnicity-based annual mortality rates of cirrhosis and hepatocellular carcinoma in the United States. Hepatology 2019;69(3):1064–74. - PMC - PubMed
    1. Asrani SK, Kouznetsova M, Ogola G, et al. Increasing health care burden of chronic liver disease compared with other chronic diseases, 2004–2013. Gastroenterology 2018;155(3):719–29.e4. - PubMed

Publication types

MeSH terms