Author information
1Sections of Gastroenterology and Hepatology and.
2Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
3VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety (IQuESt).
4Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
5Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, and Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
6Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
7UH Population Health, University of Houston, Houston, TX, USA.
8Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA.
9Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA.
Abstract
Background: There are limited longitudinal data on the cost of treating patients with cirrhosis which hampers value-based improvement initatives.
Methods: We conducted a retrospective cohort study of patients with cirrhosis seen in the Veterans Affairs healthcare system from 2011 to 2015. Patients were followed up through 2019. We identified a sex- and age-matched control cohort without cirrhosis. We estimated incremental annual health care costs attributable to cirrhosis for 4 years overall and in subgroups based on severity (compensated, decompensated), cirrhosis complications (ascites, encephalopathy, varices, hepatocellular cancer, acute kidney injury), and comorbidity (Deyo index).
Results: We compared 39,361 patients with cirrhosis and 138,964 controls. The incremental adjusted costs for caring of patients with cirrhosis were $35,029 (95% CI, $32,473-$37,585) during the first year and ranged from $14,216 to $17,629 in the subsequent 3 years. Cirrhosis complications accounted for most of these costs. Cost of managing patients with hepatic encephalopathy (year 1 cost, $50,080) or ascites ($50,364) were higher than the cost of managing patients with varices ($20,488) or hepatocellular cancer ($37,639) in the first year. Subgroups with acute kidney injury or those who had multimorbidity were the most costly at $64,413 and $66,653 in the first year, respectively.
Conclusion: Patients with cirrhosis had substantially higher healthcare costs than matched controls and multimorbid patients had even higher costs. Cirrhosis complications accounted for most of the excess cost, so preventing complications has the largest potential for cost saving and could serve as targets for improvement.