Primary biliary cholangitis (PBC) is a disease of small bile-ducts, which can lead to morbidity and mortality. Our aim was to assess recent trends in mortality and healthcare utilization of PBC patients in Medicare program.
Data from Medicare beneficiaries between 2005 and 2015 (5% random samples) were used. The diagnosis of PBC was established with ICD-9 code 571.6 used for both primary and secondary diagnoses. Mortality was assessed by Medicare-linked death registry. Healthcare utilization included episodes of care, length of stay, total charges/payments. Independent predictors of outcomes were evaluated in multiple generalized linear or logistic regression models.
The study cohort included a total of 6,375 inpatient/outpatient Medicare beneficiaries (mean age 69.8 years, 17% male, 88% white and 18% with disability). Over the study period, 1-year mortality remained stable (9.1% to 14.3%, p=0.11). Independent predictors of 1-year mortality were older age, male gender, black race, the presence of ascites, encephalopathy, hepatocellular carcinoma, and higher Charlson score. Outpatient total yearly charges and payments per beneficiary with PBC increased from $3065 and $777 (2005) to $5773 and $967 (2014), respectively. Similarly, inpatient total yearly charges and payments per beneficiary with PBC increased from $59,765 and $19,406 (2007), to $98,941and $27,948 (2013), respectively (p<0.05). The presence of ascites, portal hypertension, and higher Charlson score were independent predictors of higher payments for both inpatient and outpatient resource utilization, and the presence of hepatic encephalopathy was an additional predictor of higher inpatient resource utilization (all p<0.02).
The prevalence of PBC among the Medicare beneficiaries has increased. Despite stable mortality rates, resource utilization for Medicare patients with PBC continues to rise.