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Real-world clinical features, health-care utilization, and economic burden in decompensated cirrhosis patients: A national database

Authors
 Hankil Lee  ;  Beom Kyung Kim 
Citation
 JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Vol.37(11) : 2154-2163, 2022-11 
Journal Title
JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY
ISSN
 0815-9319 
Issue Date
2022-11
MeSH
Ascites / epidemiology ; Ascites / etiology ; Ascites / therapy ; Financial Stress ; Hemorrhage ; Hepatic Encephalopathy* / epidemiology ; Hepatic Encephalopathy* / etiology ; Hepatic Encephalopathy* / therapy ; Hepatorenal Syndrome* / epidemiology ; Hepatorenal Syndrome* / etiology ; Hepatorenal Syndrome* / therapy ; Humans ; Liver Cirrhosis / complications ; Liver Cirrhosis / epidemiology ; Liver Cirrhosis / therapy ; Patient Acceptance of Health Care
Keywords
South Korea ; cost ; decompensation ; health care ; liver cirrhosis ; utilization
Abstract
Background: Patients with decompensated cirrhosis are well known to experience morbidity and mortality.

Aim: We assessed clinical characteristics, health-care utilization, and economic burden according to the type, number, and combination of decompensation-related complications.

Methods: We used recent nationally representative sample data from 2016 to 2018, covering approximately 13% of hospitalized patients in South Korea annually. Decompensation-related complications included ascites, hepatic encephalopathy (HE), gastroesophageal variceal (GEV) bleeding, and hepatorenal syndrome (HRS).

Results: Among 14 601 patients with decompensated cirrhosis, 11 201 (76.7%) experienced ≥ 1 decompensation-related complications, and approximately three-quarters underwent hospitalization. The most prevalent decompensation-related complications were ascites (54.8%), GEV bleeding (33.2%), HE (27.4%), and HRS (3.6%). Patients with GEV bleeding exhibited the highest hospitalization rate (95.7%), and patients with HE or HRS underwent hospitalization for 4 weeks/year due to decompensated cirrhosis. Hospitalization costs were 1.9 times higher in patients with HRS than in those with ascites alone ($9022 vs $4673; P < 0.01). Once patients developed decompensation-related complications, 41.3% had ≥ 2 types of decompensation-related complications. As the number of decompensation-related complications increased from 0 to ≥ 3, health-care utilization and economic burden significantly increased in a stepwise manner; patients with ascites, GEV bleeding, and HE visited medical institutions 2.2 times more (11 vs 5/year; P < 0.01) and incurred 6.4 times greater medical expenditure ($11 060 vs $1728/year; P < 0.01) than those with ascites only.

Conclusion: A substantial proportion of patients had multiple decompensation-related complications and socioeconomic burdens for decompensated cirrhosis considering admission rate, hospital stay, and costs increased markedly, depending on the number of decompensation-related complications.
Full Text
https://onlinelibrary.wiley.com/doi/10.1111/jgh.15962
DOI
10.1111/jgh.15962
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Beom Kyung(김범경) ORCID logo https://orcid.org/0000-0002-5363-2496
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/192743
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