Care coordination for patients with cirrhosis: A “win-win” solution for patients, caregivers, providers, and healthcare expenditures

Abstract

We receive with great enthusiasm the recently published article by Morando and his colleagues from the University of Padova regarding their experience with a newmodel of care coordination in the setting of cirrhosis [1]. The burden of chronic disease is greater now than ever. In the absence of a coordinated effort to prevent, diagnose, and better manage chronic disease, we as a society will bear increasing socioeconomic costs over time. Almost one half of all Americans suffer from one or more chronic diseases [2]. Millions are diagnosed and millions more die annually from a chronic disease. This is a reflection of the changing demographics in the developed world, where mortality from communicable infectious diseases decreases and mortality from non-communicable chronic diseases continues to increase. Enormous scientific advancements in treatment have largely failed to curb this steady rise. Although current health care financing and delivery systems focus on the treatment of acute conditions, 78% of actual healthcare spending is spent on the treatment of chronic conditions [3]. The total burden of chronic diseases on the economy exceeds $1.3 trillion annually; of this amount, $277 billion is spent annually on treatment, with lost productivity totaling $1.1 trillion. At our current pace, by 2023 we can expect a 42% increase in the incidence of chronic disease, totaling $4.2 trillion annually in treatment costs and lost economic output [4]. Chronic liver disease and cirrhosis are leading causes of death in the United States and worldwide. In the United States, an estimated 30,000 new cases of cirrhosis are diagnosed each year, and cirrhosis overall accounts for over 150,000 annual hospitalizations [5]. Treatment costs associated with the sequelae of cirrhosis such as variceal bleeding, ascites, encephalopathy, and hepatocellular carcinoma exceed $4 billion annually, exclusive of estimates of lost economic output [6]. In stark contrast to most other malignancies, hepatocellular carcinoma is increasing in frequency, with associated expenditures doubling from 1988 to