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

Archita P. Desai, Prashanthinie Mohan, Brandon Nokes, Deekksha Sheth, Shannon Knapp, Malaz Boustani, Naga Chalasani, Michael B. Fallon, Elizabeth A. Calhoun

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)e00062
JournalClinical and translational gastroenterology
Volume10
Issue number7
DOIs
StatePublished - Jul 1 2019

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Fibrosis
Economics
Databases
Costs and Cost Analysis
Inpatients
Length of Stay
Mortality
Artificial Respiration
Comorbidity
Hospitalization

ASJC Scopus subject areas

  • Gastroenterology

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Increasing Economic Burden in Hospitalized Patients With Cirrhosis : Analysis of a National Database. / Desai, Archita P.; Mohan, Prashanthinie; Nokes, Brandon; Sheth, Deekksha; Knapp, Shannon; Boustani, Malaz; Chalasani, Naga; Fallon, Michael B.; Calhoun, Elizabeth A.

In: Clinical and translational gastroenterology, Vol. 10, No. 7, 01.07.2019, p. e00062.

Research output: Contribution to journalArticle

Desai, Archita P. ; Mohan, Prashanthinie ; Nokes, Brandon ; Sheth, Deekksha ; Knapp, Shannon ; Boustani, Malaz ; Chalasani, Naga ; Fallon, Michael B. ; Calhoun, Elizabeth A. / Increasing Economic Burden in Hospitalized Patients With Cirrhosis : Analysis of a National Database. In: Clinical and translational gastroenterology. 2019 ; Vol. 10, No. 7. pp. e00062.
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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.",
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AU - Nokes, Brandon

AU - Sheth, Deekksha

AU - Knapp, Shannon

AU - Boustani, Malaz

AU - Chalasani, Naga

AU - Fallon, Michael B.

AU - Calhoun, Elizabeth A.

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N2 - 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.

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