Study finds increasing health care costs for patients with alcoholic cirrhosis

Health care costs for privately insured patients with alcoholic cirrhosis are nearly twice that of non‐alcoholic cirrhosis patients in the United States, according to research presented this week at The Liver Meeting^® - held by the American Association for the Study of Liver Diseases.

Alcoholic cirrhosis (scarring of the liver due to heavy alcohol use) is a major cause of liver disease and death in the U.S., and worldwide. Rising rates of alcohol‐use disorders are predicted to lead to further increases, and investigators from the University of Michigan recently examined the prevalence, health care utilization and costs for alcoholic cirrhosis.

"My colleagues at Michigan and I began to notice that we were seeing more and more patients in our clinics and in hospital with severe alcoholic liver disease. As a result, we initiated this study to determine if what we were seeing was being found across the nation," says Jessica Mellinger, MD, clinical lecturer at Michigan Medicine's Division of Gastroenterology, whose research is supported by a 2016 AASLD Foundation Clinical and Translational Research Award.

Dr. Mellinger's team collected data spanning 2008 to 2015 on prevalence, admissions, and readmissions to healthcare facilities, and health care costs among people ages 18 to 65 with alcoholic cirrhosis. Yearly prevalence trends for alcoholic and non‐alcoholic cirrhosis were calculated. Using this data, the researchers estimated rates of complications due to portal hypertension (an obstruction of blood flow, and increase of blood pressure, in the liver) and determined the effect alcoholic cirrhosis had on total and per‐person health care costs, as well as admissions and readmissions to hospital.

Among the people studied, nearly 300,000 had cirrhosis in 2015, with 36 percent of these cases attributed to alcohol use. National prevalence of cirrhosis and alcoholic cirrhosis rose from .19 percent to .27 percent between 2008 and 2015 for cirrhosis overall, and .07 percent to .10 percent for alcoholic cirrhosis.

Dr. Mellinger's team found that patients with alcoholic cirrhosis were significantly more likely to be diagnosed long after liver deterioration had already begun, and more likely to be admitted and readmitted within 30 days. Per‐person health care costs in the first year after diagnosis were nearly double for these patients compared to patients without alcoholic cirrhosis, and direct health care costs for alcoholic cirrhosis totaled around $5 billion, making up just over half the total costs of all‐cause cirrhosis.

Dr. Mellinger plans to use this research to further explore how many alcoholic cirrhosis patients gain access to alcohol use disorder treatment and who benefits from treatment. "Because alcohol cessation is the only proven therapy that can improve outcomes in patients with alcoholic cirrhosis, we hope to find ways to help these patients stop drinking by helping them connect with alcohol use disorder treatment," explains Dr. Mellinger, who also notes the importance of early diagnosis and alcohol cessation to help improve outcomes in these patients.​