An observational study of the direct costs related to hospital admissions, mortality and premature death associated with liver disease in Portugal.

BACKGROUND: Liver disease, one of the most common causes of hospitalization worldwide, is particularly prevalent in Europe. This study aimed to determine the number of hospital discharges and admissions, mortality, premature death and costs associated with liver disease from the perspective of the National Health Service in Portugal. METHODS: A descriptive, retrospective analysis of data from 97 hospitals between 2000 and 2008, and mortality data for 2011 collected from the Portuguese National Institute of Statistics. The 9th and 10th revisions of the international classification of diseases were used to establish diagnoses. National data on demographics, average length of stay, in-patient mortality and direct costs associated with hospital admissions and liver transplantation were compared for the most common liver diseases. Mortality and premature death were compared using the potential years of life lost (PYLL) index. RESULTS: The annual mean number of discharges for liver disease was 11,503 between 2000 and 2008. Most cases of liver disease were diagnosed in men (70.4 %) and the prevalence of liver disease peaked in patients aged from 20 to 64 years (60.7 %). Alcoholic cirrhosis was the most frequent liver-disease diagnosis leading to discharge (38.6 %). In addition, alcoholic cirrhosis emerged as the main cost-driver, accounting for €26,818,930 (42.6 %) of the total cost imposed by liver disease. Overall, chronic hepatic disease was the 10th most common cause of mortality in Portugal in 2011, causing 21.8 deaths per 100,000. Chronic hepatic disease and hepatocellular carcinoma are even more important causes of premature death, ranking third based on PYLL. CONCLUSION: In 2011, liver disease was the 10th most common cause of death and the third most important cause of premature death in Portugal. Alcohol cirrhosis was the leading cause of liver-related hospital admissions between 2001 and 2008. It appears that liver disease imposes a considerable social and economic burden on Portugal. Our results suggest that educational, legislative and therapeutic interventions to prevent morbidity, mortality and premature death from liver disease are urgently required to minimise the economic and clinical burdens.

The burden of alcoholism in fifteen years of cirrhosis hospital admissions in Portugal.

BACKGROUND & AIMS: Deploying a longitudinal perspective, we observe how cirrhosis caused mortality rates in Portugal are converging with the levels reported in the European Union (15 countries). However, we still lack analysis of the burden of alcoholic cirrhosis in terms of hospital admissions and associated mortality. As Portugal may be considered a paradigmatic case in Europe, our aim was to characterize the evolution of hospital admissions for alcoholic cirrhosis between 1993 and 2008 and draw conclusions for other countries. METHODS: Retrospective analysis of the hepatic cirrhosis admissions in 97 Portuguese state hospitals was carried out based on the National Registry. RESULTS: We report a convergence in terms of mortality rates resulting from cirrhosis between Portugal and European Union (a differential of 6.7 deaths per 100 000 habitants in 1994 to 0.4 in 2008). We accounted for 81 543 hospital admissions for cirrhosis: 84% for alcoholic cirrhosis and 16% for non-alcoholic cirrhosis. Hospital admissions have increased 29% in men and with no increase in women. In the male, alcoholic cirrhosis patient group aged between 40 and 54, the rise in hospital admissions was more pronounced with an increase of around 45%. These patients underwent longer lengths of stay and reported higher mortality rates and passing away 20 years earlier than the average national expectancy of life. CONCLUSIONS: These data draw attention to the burden of alcohol consumption not only in Portugal but also in other countries and its impacts on hospital systems and on policy making.

Rising costs and hospital admissions for hepatocellular carcinoma in Portugal (1993-2005).

AIM: To determine, for hepatocellular carcinoma (HCC), the patient demographic profile and costs of their admissions to the hospitals of the Portuguese National Health System from 1993 to 2005. METHODS: The National Registry (ICD-9CM, Inter-national Classification of Diseases, 155.0) provided data from the 97 Hospitals in Portugal. RESULTS: We studied 7932 admissions that progressively rose from 292 in 1993 to 834 in 2005, having a male predominance of 78% (6130/7932). The global rate of hospital admissions for HCC rose from 3.1/10(5) in 1993 to 8.3/10(5) in 2005. The average length of stay decreased from 17.5 +/- 17.9 d in 1993 to 9.3 +/- 10.4 d in 2005, P < 0.001. The average hospital mortality for HCC remained high over these years, 22.3% in 1993 and 26.7% in 2005. Nationally, hospital costs (in Euros - EUR) rose in all variables studied: overall costs from 533,000 Euros in 1993, to 462,9000 Euros in 2005, cost per day of stay from 105 Euros in 1993, to 597 Euros in 2005, average cost of each admission from 1828 Euros in 1993, to 5550 Euros in 2005. In 2005, 1.8% (15/834) of hospital admissions for HCC were related to liver transplant, and responsible for a cost of about 1.5 million Euros, corresponding to one third of the overall costs for HCC admissions in that same year. CONCLUSION: From 1993 to 2005 hospital admissions in Portugal for HCC tripled. Overall costs for these admissions increased 9 times, with all variables related to cost analysis rising accordingly. Liver transplant, indicated in a small group of patients, showed a disproportionate increase in costs.

Acute coronary syndromes and other forms of coronary heart disease in the National Health Service, 1997-2001.

AIMS: 1) To study the frequency and distribution of acute coronary syndromes and other forms of ischemic heart disease (IHD) as the cause of hospitalization in the Portuguese National Health Service (NHS); 2) To compare mortality from the various forms of IHD by gender in NHS hospitals in the period 1997-2001. MATERIAL AND METHODS: Annual in-patient data based on Diagnosis Related Groups (DRGs) sent by each NHS hospital to the Informatics and Financial Management Institute (IGIF) using ICD-9-CM codes. After quality control of the data by IGIF, the Statistics Department of the Directorate-General of Health (GDS) studied the distribution of codes 410-414 by age group and gender. Measures of central tendency were studied and the Student's t test was used to evaluate the significance of differences between men and women in the distribution of IHD in-patients. RESULTS: Acute myocardial infarction (AMI) (410) caused 7618 hospitalizations (5271 male, 2347 female) in 1997. In 2001 the number was 10,047 (6693 male, 3354 female). Other acute and subacute forms of IHD (411) were 4005 (2522 male, 1483 female) and 4100 (2618 male, 1482 female) respectively during 1997 and 2001. Angina pectoris (413) and other forms of chronic ischemic heart disease (414) were 2479 (1543 male, 936 female) and 11,293 (7951 male, 3342 female) during 1997, and 1993 (1212 male, 781 female) and 12,029 (8277 male, 3752 female) during 2001. The age (meanSD) of in-patients coded as 410 was 63.1+/-12.9/63.9+/-17.0 years in men and 72.4+/-11.6/73.1+/-11.1 years in women over the period 1997-2001. Age differences by gender were statistically significant (p < 0.001). Age for code 411 was similar to AMI in men (62.9+/-11.1 years and 63.8+/-11.7 years respectively in 1997 and 2001), but was lower in AMI cases in women (68.4+/-10.6 years and 69.3+/-10.7 years respectively in 1997 and 2001). AMI mortality was higher in 1997 (11.6% male, 22.1% female) than in 2001 (9.9% male, 19.8% female). CONCLUSIONS: Acute coronary events are the cause of approximately half of the hospitalizations for IHD, in both sexes. The frequency of every form of IHD in men is higher than in women, and hospitalization occurs nine years earlier on average. Between 1997 and 2001, hospitalizations for IHD increased by over 10%, mainly for AMI (32%), although with no significant increase in age. Nevertheless, the prognosis for AMI in in-patients has improved in both sexes.