Skip to main content

Advertisement

SpringerLink
Log in

Charges for Alcoholic Cirrhosis Exceed All Other Etiologies of Cirrhosis Combined: A National and State Inpatient Survey Analysis

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Inpatient charges for patients with cirrhosis are substantial. We aimed to examine trends in inpatient charges among patients with cirrhosis to determine the drivers of healthcare expenditures. We hypothesized that alcoholic cirrhosis (AC) was a significant contributor to overall expense.

Methods

We performed a retrospective analysis of the Health Care Utilization Project Nationwide Inpatient Sample Database 2002–2014 (annual cross-sectional data) and New York and Florida State Inpatient Databases 2010–2012 (longitudinal data). Adult patients with cirrhosis of the liver were categorized as AC versus all other etiologies of cirrhosis combined. Patient characteristics were analyzed using ordinary least squares regression modeling. A random effects model was used to evaluate 30-day readmissions.

Results

In total, 1,240,152 patients with cirrhosis were admitted between 2002 and 2014. Of these, 567,510 (45.8%) had a diagnosis of AC. Total charges for AC increased by 95.7% over the time period, accounting for 59.9% of all inpatient cirrhosis-related charges in 2014. Total aggregate charges for AC admissions were $28 billion and increased from $1.4B in 2002 to $2.8B by 2014. In the NIS and SID, patients with AC were younger, white and male. Readmission rates at 30, 60, and 90 days were all higher among AC patients.

Conclusions

Inpatient charges for cirrhosis care are high and increasing. Alcohol-related liver disease accounts for more than half of these charges and is driven by sheer volume of admissions and readmissions of the same patients. Effective alcohol addictions therapy may be the most cost-effective way to substantially reduce inpatient cirrhosis care expenditures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

AC:

Alcoholic cirrhosis

HCV:

Hepatitis C

NAFLD:

Nonalcoholic fatty liver disease

NIS:

Nationwide Inpatient Sample

HCUP:

Healthcare Cost and Utilization Project

AHRQ:

Agency for Healthcare Research and Quality

SID:

State Inpatient Database

ICD-9-CM:

International Classification of Diseases, 9th Revision, Clinical Modification

NC:

Nonalcohol-related cirrhosis

References

  1. Bodenheimer T. High and rising health care costs. Part 1: seeking an explanation. Ann Intern Med. 2005;142:847–854.

    Article  PubMed  Google Scholar 

  2. Schmidt ML, Barritt AS, Orman ES, et al. Decreasing mortality among patients hospitalized with cirrhosis in the United States from 2002 through 2010. Gastroenterology. 2015;148:967-977 e2.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Peery AF, Crockett SD, Barritt AS, et al. Burden of gastrointestinal, liver, and pancreatic diseases in the United States. Gastroenterology. 2015;149:1731-1741.e3.

    PubMed  PubMed Central  Google Scholar 

  4. Peery AF, Crockett SD, Murphy CC, et al. Burden and cost of gastrointestinal, liver, and pancreatic diseases in the United States: update 2018. Gastroenterology. 2019;156:254-272.e11.

    Article  PubMed  Google Scholar 

  5. Ndugga N, Lightbourne TG, Javaherian K, et al. Disparities between research attention and burden in liver diseases: implications on uneven advances in pharmacological therapies in Europe and the USA. BMJ Open. 2017;7:e013620.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Williams R, Alexander G, Armstrong I, et al. Disease burden and costs from excess alcohol consumption, obesity, and viral hepatitis: fourth report of the Lancet Standing Commission on Liver Disease in the UK. Lancet. 2018;391:1097–1107.

    Article  PubMed  Google Scholar 

  7. O’Shea RS, Dasarathy S, McCullough AJ. Alcoholic liver disease. Hepatology. 2010;51:307–328.

    Article  PubMed  Google Scholar 

  8. Griswold MG, Fullman N, Hawley C, et al. Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2018;392:1015–1035.

    Article  Google Scholar 

  9. HCUP Nationwide Inpatient Survey (NIS). 2002–2010. www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed 2 May 2017.

  10. Kramer JR, Davila JA, Miller ED, et al. The validity of viral hepatitis and chronic liver disease diagnoses in Veterans Affairs administrative databases. Aliment Pharmacol Ther. 2008;27:274–282.

    Article  CAS  PubMed  Google Scholar 

  11. Liu TL, Trogdon J, Weinberger M, et al. Diabetes is associated with clinical decompensation events in patients with cirrhosis. Dig Dis Sci. 2016;61:3335–3345.

    Article  PubMed  Google Scholar 

  12. Orman ES, Hayashi PH, Bataller R, et al. Paracentesis is associated with reduced mortality in patients hospitalized with cirrhosis and ascites. Clin Gastroenterol Hepatol. 2014;12:496-503 e1.

    Article  PubMed  Google Scholar 

  13. Zou G. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159:702–706.

    Article  PubMed  Google Scholar 

  14. Zou GY, Donner A. Extension of the modified Poisson regression model to prospective studies with correlated binary data. Stat Methods Med Res. 2013;22:661–670.

    Article  CAS  Google Scholar 

  15. Molenberghs G, Verbeke G, Demetrio CG. An extended random-effects approach to modeling repeated, overdispersed count data. Lifetime Data Anal. 2007;13:513–531.

    Article  PubMed  Google Scholar 

  16. Orman ES, Hayashi PH, Bataller R, et al. Paracentesis is Associated with Reduced Mortality in Patients Hospitalized with Cirrhosis and Ascites. Clin Gastroenterol Hepatol. 2013;12:496–503.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Le S, Spelman T, Chong CP, et al. Could adherence to quality of care indicators for hospitalized patients with cirrhosis-related ascites improve clinical outcomes? Am J Gastroenterol. 2016;111:87–92.

    Article  PubMed  Google Scholar 

  18. Oppedal K, Moller AM, Pedersen B, et al. Preoperative alcohol cessation prior to elective surgery. Cochrane Database Syst Rev. 2012. https://doi.org/10.1002/14651858.CD008343.pub2.

    Article  PubMed  Google Scholar 

  19. Case A, Deaton A. Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proc Natl Acad Sci USA. 2015;112:15078–15083.

    Article  CAS  PubMed  Google Scholar 

  20. Denniston MM, Jiles RB, Drobeniuc J, et al. Chronic hepatitis C virus infection in the United States, National Health and Nutrition Examination Survey 2003 to 2010. Ann Intern Med. 2014;160:293–300.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Armstrong GL, Wasley A, Simard EP, et al. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med. 2006;144:705–714.

    Article  Google Scholar 

  22. Alter MJ, Kruszon-Moran D, Nainan OV, et al. The prevalence of hepatitis C virus infection in the United States, 1988 through 1994. N Engl J Med. 1999;341:556–562.

    Article  CAS  PubMed  Google Scholar 

  23. Morse A, Barritt AS, Jhaveri R. Individual state Hepatitis C data supports expanding screening beyond baby boomers to all adults. Gastroenterology. 2018;154:1850–1851.e2.

    Article  PubMed  Google Scholar 

  24. Barritt AS, Lee B, Runge T, et al. Increasing prevalence of hepatitis c among hospitalized children is associated with an increase in substance abuse. J Pediatr. 2018;192:159–164.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, UNC Liver Center, The University of North Carolina at Chapel Hill, 8004 Burnett Womack, CB #7584, Chapel Hill, NC, 27599-7584, USA

    A. Sidney Barritt IV, Monica Schmidt, Paul H. Hayashi & Ramon Bataller

  2. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA

    Yue Jiang

  3. Center for Outcomes Research and Evaluation, Carolinas Healthcare System, Charlotte, NC, USA

    Monica Schmidt

  4. Center for Liver Diseases, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Ramon Bataller

Authors
  1. A. Sidney Barritt IV
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yue Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Monica Schmidt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paul H. Hayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ramon Bataller
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Sidney Barritt IV.

Ethics declarations

Conflict of interest

The authors have no relevant conflicts to disclose.

Appendix 1: Additional Cirrhosis-Related ICD-9 Codes Used

Appendix 1: Additional Cirrhosis-Related ICD-9 Codes Used

  1. 1.

    Alcoholic cirrhosis: 5712

  2. 2.

    Nonalcoholic cirrhosis: 5715

  3. 3.

    Biliary cirrhosis: 5716

  4. 4.

    Variceal hemorrhage: 4560, 53082, 53140, 53240, 5789, 5780

  5. 5.

    Encephalopathy: 5722

  6. 6.

    Ascites: 7895, 78951, 78959

  7. 7.

    Portal hypertension: 5723

  8. 8.

    Sepsis: 99591

  9. 9.

    Hepatorenal syndrome: 5724

  10. 10.

    Hepatocellular carcinoma (HCC): 1550

  11. 11.

    Hepatitis B (HBV): 07020-3, 07030-3, 07042

  12. 12.

    Hepatitis C (HCV): 07041, 07044, 07054

  13. 13.

    Acute Kidney Injury (AKI): 5845-9

  14. 14.

    Liver transplant: 505, 5051, 5059, V427 (or procedure codes 5051, 5059, 505, 0091, 0092, 0093)

  15. 15.

    Alcoholic hepatitis: 5711

  16. 16.

    Acute pancreatitis: 5770

  17. 17.

    Chronic pancreatitis: 5771

  18. 18.

    Primary Sclerosing cholangitis (PSC): 5761

  19. 19.

    Primary Biliary Cirrhosis/Cholangitis (PBC): 5716

  20. 20.

    Spontaneous Bacterial Peritonitis (SBP): 56723, 567, 5672, 5678, 5679

  21. 21.

    Transfusion: 9904, 9905, 9907

  22. 22.

    Esophagogastroduodenoscopy (EGD): 4513, 4233, 4516, 4443

  23. 23.

    Paracentesis: 5491

  24. 24.

    Thoracentesis: 3491

  25. 25.

    Trans-jugular intrahepatic portosystemic shunt (TIPS): 391

  26. 26.

    Hemodialysis: 3995

  27. 27.

    Mechanical ventilation > 96 h: 9672

  28. 28.

    Alcohol detoxification: 9462

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Barritt, A.S., Jiang, Y., Schmidt, M. et al. Charges for Alcoholic Cirrhosis Exceed All Other Etiologies of Cirrhosis Combined: A National and State Inpatient Survey Analysis. Dig Dis Sci 64, 1460–1469 (2019). https://doi.org/10.1007/s10620-019-5471-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-019-5471-7

Keywords

Search

Navigation