Real‐world clinical features, health‐care utilization, and economic burden in decompensated cirrhosis patients: A national database

Abstract

Background: Patients with decompensated cirrhosis are well known to experience morbidity and mortality. Aim: We assessed clinical characteristics, health-care utilization, and economic burden according to the type, number, and combination of decompensation-related complications. Methods: We used recent nationally representative sample data from 2016 to 2018, covering approximately 13% of hospitalized patients in South Korea annually. Decompensation-related complications included ascites, hepatic encephalopathy (HE), gastroesophageal variceal (GEV) bleeding, and hepatorenal syndrome (HRS). Results: Among 14 601 patients with decompensated cirrhosis, 11 201 (76.7%) experienced ≥ 1 decompensation-related complications, and approximately three-quarters underwent hospitalization. The most prevalent decompensation-related complications were ascites (54.8%), GEV bleeding (33.2%), HE (27.4%), and HRS (3.6%). Patients with GEV bleeding exhibited the highest hospitalization rate (95.7%), and patients with HE or HRS underwent hospitalization for 4 weeks/year due to decompensated cirrhosis. Hospitalization costs were 1.9 times higher in patients with HRS than in those with ascites alone ($9022 vs $4673; P < 0.01). Once patients developed decompensation-related complications, 41.3% had ≥ 2 types of decompensation-related complications. As the number of decompensation-related complications increased from 0 to ≥ 3, health-care utilization and economic burden significantly increased in a stepwise manner; patients with ascites, GEV bleeding, and HE visited medical institutions 2.2 times more (11 vs 5/year; P < 0.01) and incurred 6.4 times greater medical expenditure ($11 060 vs $1728/year; P < 0.01) than those with ascites only. Conclusion: A substantial proportion of patients had multiple decompensation-related complications and socioeconomic burdens for decompensated cirrhosis considering admission rate, hospital stay, and costs increased markedly, depending on the number of decompensation-related complications.

Impact of decompensated cirrhosis in children: A population-based study

“…Children with decompensated cirrhosis tend to visit GI physicians more frequently in our study, similar to adult data indicating higher utilization of health care in patients with decompensation (7). The social determinants of health, including income quintiles, have a significant impact on overall health, including liver health (8).…”

Quantifying days at home in patients with cirrhosis: A national cohort study

“…Within the cirrhosis cohort, we found meaningful differences that varied by both decompensation status and etiology. Health care use has been shown to increase with liver decompensation, and our work builds on this finding by quantifying how utilization changes depending on the exact nature of decompensation 45,46 . Specifically, ascites and HE alone are both individually associated with a 1-month reduction in DAH, and together they are associated with a more than 2-month reduction in DAH.…”

“…Health care use has been shown to increase with liver decompensation, and our work builds on this finding by quantifying how utilization changes depending on the exact nature of decompensation. [45,46] Specifically, ascites and HE alone are both individually associated with a 1-month reduction in DAH, and together they are associated with a more than 2-month reduction in DAH. The addition of variceal bleeding to any of these decompensated states seemed to have little effect on DAH.…”

Epidemiology of liver cirrhosis and associated complications: Current knowledge and future directions

“…Of 103165 patients with cirrhosis, 16550 had ascites (16%)[ 61 ]. A further Korean study using a nationally representative database yielded a real-world burden of complications in patients with decompensated cirrhosis from 2016 to 2018, with ascites being the most common decompensated event (54.8%), followed by GEV bleeding, HE and hepatorenal syndrome (HRS)[ 62 ]. However, recent epidemiological information related to ascites in cirrhosis is relatively scarce.…”

“…The overall prevalence rates of PRA and ATN in patients with cirrhosis are 15%-45% and 15%-60%, respectively, which are higher than the 10-40% rate of HRS[ 104 ]. The prevalence of HRS in patients with decompensated cirrhosis was 3.6%, while the median LOS for HRS was 4 wk per year in a large representative Korean database from 2016-2018, significantly higher than that for patients with ascites (19 d) or GEV bleeding (13 d)[ 62 ]. A recent study that included patients with a primary diagnosis of HRS in the NIS from 2008-2018 found a notable increase in the number of HRS hospitalizations from 22864 in 2008 to 42985 in 2018; however, there was a decreasing trend in inpatient mortality (36.2% in 2008 to 25.7% in 2018)[ 105 ].…”