Stanford University Medical Center, United States. Electronic address: email@example.com.
Gilead Sciences, Inc., United States.
University of Washington, United States.
IBM Watson Health, India.
Henry Ford Hospital, United States.
University College London, United Kingdom; King's College Hospital, United Kingdom.
Yale University School of Medicine, United States.
Chronic hepatitis B (CHB) affects over 2 million people in the United States (US), with little reported on healthcare utilization and cost. We aimed to quantify annual CHB utilization and costs by disease severity and payer type.
Using Commercial, Medicare, and Medicaid databases from 2004 to 2015 and ICD9 codes, we retrospectively identified CHB adults analyzing all-cause inpatient, outpatient, and pharmaceutical utilization and costs by disease severity. We compared healthcare utilization and costs between CHB patients without advanced liver disease to matched non-CHB patients. All-cause inpatient, outpatient, and pharmaceutical utilization and costs were reported for each year and adjusted to 2015 dollars.
Our sample consisted of 33,904 CHB cases and 86,072 non-CHB controls. All-cause inpatient admissions (average stay 6-10 days) were more frequent in advanced liver disease states. Across all payers, patients with decompensated cirrhosis had the highest emergency department utilization (1.6-2.8 annual visits) and highest mean annual costs. The largest all-cause cost components for Commercial and Medicaid were inpatient costs for all advanced liver disease groups (Commercial: 62%, 47%, 68%; Medicaid: 81%, 72%, 74%, respectively), and decompensated cirrhosis and hepatocellular carcinoma groups for Medicare (Medicare 49% and 48%). In addition, compensated liver disease patients had three times the cost of non-CHB controls.
CHB patients, regardless of payer, who experienced decompensated cirrhosis, HCC, or a liver transplant incurred the highest annual costs and utilization of healthcare resources but even patients with CHB compensated liver disease incurred higher costs compared to those without CHB. All stakeholders in disease management need to combine efforts to prevent infection and advanced liver disease through improved vaccination rates, earlier diagnosis, and treatment.
Hepatitis B virus can be a progressive disease leading to cirrhosis, hepatocellular carcinoma, liver transplant, and death. These progressive disease states are associated with a higher rate of hospitalizations, emergency room visits, outpatient visits, and costs compared to similar patients without hepatitis B. The most ill patients have the highest costs, but even less sick patients experience high costs compared to patients without hepatitis B.