Primary Biliary Cholangitis (PBC) Is Associated With Significant Mortality and Health Care Utilization (HCU) in Medicare Population

Abstract

Introduction: PBC can lead to morbidity, mortality, and HCU. We assessed recent trends in HCU and mortality for PBC patients enrolled in Medicare program. Methods: We used 5% random samples of Medicare beneficiaries (2005-2015) for inpatient/outpatient services. PBC included ICD-9 code of 571.6 as both primary and secondary diagnoses. We assessed HCU [episodes of care, length of inpatient stay (LoS), total charges/payments) and short-term mortality. Independent predictors of outcomes were evaluated in multiple generalized linear or logistic regression models. Results: Out of 2.8 million Medicare claims, 6,375 were for PBC. Proportion of Medicare-PBC increased from 21.0 (2005-2008) to 25.6 (2014) per 100,000 (p=0.001). Demographics of PBC cohort remained the same for the study period: age 69.8±9.9, 17% male, 88% white, 19% enrolled due to disability (all p>0.10). Total outpatient claims were 11,140 for 5,284 unique patients. The number outpatient claims per patient per year ranged from 1.9 to 2.2 (p=0.31), total per patient per year charges ranged from $3,065 (2005) to $5,773 (2014) (p < 0.05) and the average total per-patient-per-year (PPPY) payments ranged from $641 (2008) to $967 (2014) in 2016 U.S. dollars (p=0.10) with patients-paid share ranging from 15% to 19% (p=0.59). Independent predictors of higher outpatient spending included ascites, hepatic encephalopathy, portal hypertension, hepatocellular carcinoma and Charlson score (CCS)>1 (betas from $325 to $744 per condition; p < 0.01). One-year mortality in PBC remained stable over time (9% to 14%, p=0.11). Independent predictors of one-year mortality included older age, male gender, black or Hispanic race, ascites, hepatic encephalopathy and higher CCS (p < 0.05). Inpatient claims were 2,802 for 1,928 unique patients (#claims per patient 1.36 to 1.57, p=0.88). Average total inpatient charges increased from $60,411 (2005) to $73,662 (2014) (p=0.01), while PPPY payments ranged from $18,322 to $28,107 (p=0.48) with patients-paid share ranging from 9% to 13% (p=0.48). Independent predictors of higher inpatient spending were younger age, disability, and hepatic de-compensation (beta from $8,663 to $14,010 per condition, p < 0.04). Ascites, hepatic encephalopathy, higher CCS and longer inpatient stay were also associated with higher inpatient mortality in PBC (p < 0.03). Conclusion: PBC is an important liver disease associated with mortality and HCU. The prevalence and HCU of PBC in Medicare population is increasing.