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

Abstract

Patients with decompensated cirrhosis are well known to experience morbidity and mortality. We assessed clinical characteristics, health-care utilization, and economic burden according to the type, number, and combination of decompensation-related complications. 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). Among 14601 patients with decompensated cirrhosis, 11201 (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 4weeks/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 ($11060 vs $1728/year; P<0.01) than those with ascites only. 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.