Alcoholic cirrhosis outpaces non-alcoholic cirrhosis in use of resources

WASHINGTON — Patients with alcohol-associated cirrhosis required more health care resource utilization, including hospital stays, than patients with non-alcoholic cirrhosis, according to findings presented at The Liver Meeting 2017.

“Alcoholic cirrhosis is a big problem in the United States,” Jessica L. Mellinger, MD, of the department of Internal Medicine-Hepatology at the University of Michigan, said. “We don’t have good treatments for it, other than to encourage abstinence. Finding out what the burden is in the United States helps direct policy towards this.”

Mellinger and colleagues, collected a cross-section of U.S. national data on prevalence rates, hospital admissions and readmissions, along with health care costs for 294,561 patients with cirrhosis. They aimed to determine the impact of alcoholic cirrhosis on these metrics.

The national prevalence rate of cirrhosis was 0.27% nationally in 2015, according to the results. Of those patients, 37% had alcoholic cirrhosis, comprising a 0.1% national prevalence rate.

Cirrhosis rates increased from 0.20% to 0.27% between 2008 and 2015. During that same span, rates of alcoholic cirrhosis increased from 0.07% to 0.1%.

“We found three things: Number one, the numbers were rising,” Mellinger said.

Patients with alcoholic cirrhosis were significantly more likely to have ascites than their non-alcoholic counterparts, 20% vs. 7% (P < .05). Alcoholic cirrhosis was also associated with significantly more hepatic encephalopathy (6% vs. 1%) and variceal bleeding (4% vs. 1%), according to the results (P < .05 for all).

“The second major finding in terms of burden was that the portal hypertensive related complications — the kinds of things that kill our patients — were much more common in alcohol-related patients at presentation, and also 2 years down the road,” Mellinger said. “When we looked again and modeled this out to 2 years after diagnosis, they had significantly greater rates of these complications.”

Alcoholic cirrhosis patients experienced 27.3 excess hospital admissions for cirrhosis and alcohol-related reasons per 100 patients compared with non-alcoholic cirrhotics. A similar trend was reported for 30-day readmissions (8.2 excess readmissions per 100 patients).

“They were also admitted and readmitted much more frequently than patients who did not have alcohol-related cirrhosis,” Mellinger said. “They are using a lot more of the health care system.”

In the first year after index diagnosis, per-person health care utilization costs were $44,835 for alcoholic cirrhotics and $23,319 for non-alcoholic cirrhotics (P < .05). The total direct health care cost for all ALD patients was $5 billion, according to the findings.

“We are all very interested in cost,” Mellinger said. “They’re making up a third of the cirrhosis population, but they’re using approximately half of the cost.” – by Rob Volansky

For more information:

Mellinger JL, et al. Abstract 169. Presented at: The Liver Meeting; Oct. 20-24, 2017; Washington, D.C.

Disclosure: Mellinger reports no relevant financial disclosures.

Editor's note: This has been updated to reflect final data presented at the meeting.