WASHINGTON — Alcoholic patients with cirrhosis are generally sicker and cost the health system more than their non-alcoholic counterparts, researchers said here.
In a study of about 216,000 hospital admissions of cirrhosis patients in 2015, patients with alcoholism had 27.3 excess all-cause hospital admissions per 100 enrollees compared with cirrhosis patients who were not alcoholic, according to Jessica Mellinger, MD, of the University of Michigan, in Ann Arbor, and colleagues. They also had 8.2 excess readmissions and 7.2 excess cirrhosis-related admissions.
And these patients cost more: alcoholic cirrhosis patients account for about $5 billion of a total of $9.5 billion in cirrhosis costs, even though they comprise only about a third of cirrhosis patients, Mellinger said during a press briefing at the at the Liver Meeting, the annual conference of the American Association for the Study of Liver Diseases (AASLD).
“Alcoholic cirrhosis … is a big problem in U.S. and worldwide,” she said. “Worldwide, we think it causes 50% of liver-related mortality.”
And the numbers are rising: the nationwide prevalence of cirrhosis overall rose from 0.19% to 0.27% between 2009 and 2015; for alcoholic cirrhosis, it rose from 0.09% to 0.13%. Patients younger than age 45 had a three-fold increase in alcoholic cirrhosis incidence, from 0.01% to 0.03%.
“We find patients in our clinic who are drinking, and we refer them to alcohol addiction treatment and they don’t go; they might stop drinking or they might not,” said Mellinger. “Finding out what the burden in the U.S. may help with directing policy.”
In particular, “we noticed we had a lot of patients in our hospital — patients in their 20s and 30s dying of alcohol-related liver disease,” said Mellinger. To find out more, the researchers looked at a database containing 500 million insurance claims from more than 100 large employers. They searched for ICD-9 or ICD-10 diagnosis codes for both cirrhosis (571.2) and cirrhosis not related to alcohol (571.5), for patients ages 18-64.
Encephalopathy was much more common at baseline in alcoholic cirrhosis patients than non-alcoholic ones (6% versus 1%, P<0.001), Mellinger said. Their rates of ascites (22% versus 8%) and acute kidney injury also were significantly higher (8% versus 4%). "Patients who develop ascites -- we see this as a marker of death long term. Your death rate goes way up once you develop ascites."
Costs were higher as well: $44,835 per person in total healthcare costs for cirrhosis patients with alcoholism compared with $23,319 for cirrhosis patients without it.
“I think the [higher costs] are because these patients have more complications and are admitted to the hospital more frequently,” she added. “If they’re actively drinking they will have more of these complications. If we help them stop completely, those rates go down.”
One limitation of the study was that it only included private healthcare data and no data from public programs such as Medicare and Medicaid, Mellinger noted.
The results suggest a need for better coordination of care, she said. “Many of these patients never get to the liver clinic; they’re often seen in primary care clinics [instead] … How can we coordinate care with primary care physicians and mental health/addiction specialists too? It’s not clear why people don’t get referred [for treatment] — do they not get as much medical care? Are they presenting later, once they have symptoms? The problem is most likely mutifactorial, and I don’t have a great answer as to why patients are not coming to our attention earlier.”
The total numbers presented in this study “are sort of staggering, but the most compelling information was the increase among young individuals in alcoholic cirrhosis,” said AASLD press briefing Norah Turreault, MD, of the University of California San Francisco. “I, too in my practice, am seeing 20-year-olds presenting with cirrhosis.” The results highlight the need to “get more prevention messages out there,” she said.
Mellinger disclosed no relevant relationships with industry.
Terrault disclosed relevant relationships with Dynavax, Gilead, Bristol Myers Squibb, Novartis, Merck, Intercept, Biotest, Vertex, AbbVie, and Eisai.