Mortality and costs associated with alcoholic hepatitis: A claims analysis of a commercially insured population.

Rising mortality in the United States due to alcoholic liver disease (ALD) and the dearth of effective treatments for ALD have led to increased research in this area, particularly in alcoholic hepatitis. To understand the burden of illness and potential economic value of effective treatments, we conducted a health care claims analysis of over 15,000 commercially insured adults who were hospitalized with alcoholic hepatitis (AH) between 2006 and 2013 and followed for up to 5 years. Their average age was 54 years and 68% were male. Over 5 years, about two-thirds of these adults died (44% in the first year), and fewer than 500 received liver transplants. There were nearly 40,000 re-hospitalizations, with over 50% of the survivors re-hospitalized within a year and nearly 75% through the second year. The total costs were nearly $145,000 per patient, with costs decreasing over time from over $50,000 in the first year (including the index hospitalization) to about $10,000 per year in the later years. Total costs for the cohort over 5 years were $2.2 billion. Patients who received a liver transplant averaged about $300,000 in transplant-related costs and over $1,000,000 in total health care costs over 5 years. Average costs in years following the index hospitalization were similar to diabetes. AH has a high mortality and is a high-cost condition.

Trends in Alcoholic Hepatitis-related Hospitalizations, Financial Burden, and Mortality in the United States.

BACKGROUND: Alcoholic hepatitis (AH) is the most florid manifestation of alcoholic liver disease which accounts for significant morbidity, mortality, and financial burden. Aim of this study is to evaluate temporal trend of hospitalizations from AH and evaluate its financial impact. METHODS: The National Inpatient Sample databases (from 2002 to 2010) which are collected as part of Healthcare Cost and Utilization Project by Agency for Healthcare Research and Quality were utilized. Individuals aged 21 years and older were included. The hospitalizations with primary diagnosis of AH were captured by ICD-9 codes. The national estimates of hospitalization were derived using sample weights provided by National Inpatient Sample. Simple linear regression method was used to assess trends in mortality and length of stay over time. RESULTS: We observed the increased in total cases of AH-related hospitalization from 249,884 (0.66% of total admission in 2002) to 326,403 (0.83% of total admission in 2010). The significant increase in the total admission rate was attributable mainly to the rise in inpatient hospitalization for secondary diagnosis of AH (0.48% in 2002 to 0.67% in 2010). Most of the AH-related hospitalization were males. Hepatic encephalopathy was found to be the most common admitting diagnosis for individuals hospitalized with secondary diagnosis of AH (8.9% in 2002 and 8.6% in 2010). There was a significant decrease in inpatient mortality for primary diagnosis of AH from 10.07% (in 2002) to 5.76% (in 2010) (absolute risk reduction: 4.3%). Average cost of hospitalization related to primary diagnosis of AH was $27,124 and $46,264 in 2002 and 2010, respectively. After adjusting for inflation, the additional cost of each hospitalization seemed to increase by 40.7% in 2010 compared with 2002 (additional cost per hospitalization $11,044 in 2010 compared with 2002). Federal (Medicare) or state (Medicaid) supported health insurance program are the main primary expected payers for these AH hospitalizations (∼25% to 29%). Despite increase in cost per hospitalization, length of stay for hospitalization due to primary diagnosis of AH was not observed to decrease substantially over time (6.7 d in 2002 to 6.1 d in 2010). CONCLUSIONS: AH-related hospitalization continued to increase during the study period, despite the decrease in the in-hospital mortality rate. Substantial increases in health care cost and utilization among hospitalized AH patients were observed.

Hepatitis C as a prognostic indicator among noncirrhotic patients hospitalized with alcoholic hepatitis.

OBJECTIVE: A nationwide analysis of alcoholic hepatitis (AH) admissions was conducted to determine the impact of hepatitis C virus (HCV) infection on short-term survival and hospital resource utilization. METHODS: Using the Nationwide Inpatient Sample, noncirrhotic patients admitted with AH throughout the United States between 1998 and 2006 were identified with diagnostic codes from the International Classification of Diseases, Ninth Revision. The in-hospital mortality rate (primary end point) of AH patients with and without co-existent HCV infection was determined. Hospital resource utilization was assessed as a secondary end point through linear regression analysis. RESULTS: From 1998 to 2006, there were 112,351 admissions for AH. In-hospital mortality was higher among patients with coexistent HCV infection (41.1% versus 3.2%; P=0.07). The adjusted odds of in-hospital mortality in the presence of HCV was 1.48 (95% CI 1.10 to 1.98). Noncirrhotic patients with AH and HCV also had longer length of stay (5.8 days versus 5.3 days; P<0.007) as well as greater hospital charges (US$25,990 versus US$21,030; P=0.0002). CONCLUSIONS: Among noncirrhotic patients admitted with AH, HCV infection was associated with higher in-hospital mortality and resource utilization.

Clinical characteristics and mortality of hospitalized alcoholic hepatitis patients in the United States.

BACKGROUND AND AIMS: Alcoholic hepatitis (AH) is the most florid manifestation of alcoholic liver disease. In this study, we examined the clinical characteristics and risk factors associated with mortality in hospitalized AH patients in the United States using the 2007 Nationwide inpatient sample of the Healthcare Cost and Utilization Project. METHODS: Patients who were hospitalized with the primary diagnosis of AH in the United States in 2007 were identified using International Classification of Diseases-9 code. We further characterized these subjects based on associated symptoms (such as ascites, hepatic encephalopathy, and coagulopathy), complications during hospitalization (such as sepsis, pneumonia, spontaneous bacterial peritonitis, and acute renal failure), and categories pertaining to hospital characteristics, such as teaching status. The predictors of mortality were calculated using logistic regression analyses. RESULTS: There were 8,043,415 in-patient admissions, of which 56,809 (0.71%) were hospitalized with the primary diagnosis of AH. The mean age was 53.2 years, and 27% were female. The average length of stay was 6.5±7.7 days and 3,881 subjects (6.8%) died during hospitalization. Medicare and Medicaid were the main primary expected payer sources (51.8%) with the average total charges during hospital stay of $37,769. In the multivariate analyses, older age, presence of sepsis, spontaneous bacterial peritonitis, pneumonia, urinary tract infection, acute renal failure, hepatic encephalopathy, and coagulopathy were independently associated with in-patient mortality. CONCLUSIONS: In-hospital mortality rate for AH remains high, especially in those with infectious complications, hepatic encephalopathy, coagulopathy, and acute renal failure. Our analysis documented significant healthcare cost and utilization among hospitalized AH patients.