Abstract
Studies assessing the costs of alcoholic liver disease are lacking. We aimed to calculate the costs of hospitalisations before and after diagnosis compared to population controls matched by age, sex and socio-economic deprivation. We aimed to use population level data to identify a cohort of individuals hospitalised for the first time with alcoholic liver disease in Scotland between 1991 and 2011.Incident cases were classified by disease severity, sex, age group, socio-economic deprivation and year of index admission. 5 matched controls for every incident case were identified from the Scottish population level primary care database. Hospital costs were calculated for both cases and controls using length of stay from morbidity records and hospital-specific daily rates by specialty. Remaining lifetime costs were estimated using parametric survival models and predicted annual costs. 35,208 incident alcoholic liver disease hospitalisations were identified. Mean annual hospital costs for cases were 2.3 times that of controls pre diagnosis (£804 higher) and 10.2 times (£12,774 higher) post diagnosis. Mean incident admission cost was £6,663. Remaining lifetime cost for a male, 50–59 years old, living in the most deprived area diagnosed with acoholic liver disease was estimated to be £65,999 higher than the matched controls (£12,474 for 7.43 years remaining life compared to £1,224 for 21.8 years). In Scotland, alcoholic liver disease diagnosis is associated with significant increases in admissions to hospital both before and after diagnosis. Our results provide robust population level estimates of costs of alcoholic liver disease for the purposes of health-care delivery, planning and future cost-effectiveness analyses.
Highlights
Alcoholic Liver Disease (ALD) accounts for significant morbidity, mortality and economic burden worldwide[1]
We obtained anonymised individual level data on all hospital admissions for patients who were admitted with ALD in a principal or secondary diagnostic position on at least one occasion between 1981 and 2011, including sex, age group and Scottish Index of Multiple Deprivation (SIMD) quintiles from Information Services Division (ISD), National Health Service (NHS) National Services Scotland (NSS)
We identified 35,208 incident ALD admissions in the period between 1991 and 2011
Summary
Alcoholic Liver Disease (ALD) accounts for significant morbidity, mortality and economic burden worldwide[1]. There is much uncertainty surrounding trends and the level of burden associated with ALD across Europe [5,6] as comparisons are hindered by the complex aetiology of liver disease [5], issues with late diagnosis and under-reporting of alcohol as a contributing factor [5]. Studies looking at the costs associated with ALD have estimated either population level costs [7,8] or episode based costs [9,10] and have not distinguished incident cases from readmissions. To our knowledge there are no studies which examine the costs associated with individual cases of ALD nor any costs studies using matched controls. Use of population level data and the comparison with matched controls enabled us to produce a robust estimate of the additional hospital costs of an incident ALD case in Scotland. High quality cost of illness studies are valuable for health-care policy makers and planners, and provide valuable information for future cost-effectiveness studies of interventions that aim to prevent incident cases or improve individual prognosis
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