Alcoholic Cirrhosis Imposes Financial Burden on US Healthcare

Jessica Mellinger, MD

Alcoholic liver disease (ALD) is rising, with patients more likely to get diagnosed in the later stages of the disease. The result could eventually become higher healthcare costs in the US, according to a new study.

Jessica Mellinger, MD, gastroenterologist and researcher at the University of Michigan Institute for Healthcare Policy and Innovation, told MD Magazine her team had recently been seeing more patients with advanced alcohol-related liver disease.

“When these patients with alcoholic cirrhosis are first diagnosed, they tend to be sicker and have more complications of liver disease, on average, than non-alcoholic cirrhosis patients, indicating that we are missing this diagnosis early,” Mellinger said.

In addition to chronic alcohol abuse, other causes of cirrhosis include viral hepatitis C (HCV) and fat accumulation around the liver. Complications of cirrhosis include chronic infections, internal bleeding, jaundice, increased risk of liver cancer, and liver failure.

Data for the study was taken from the 2009-2015 MarketScan Commercial Claims and Encounters database, one of the largest private insurance administrative datasets containing private, employer-based insurance claims from more than 100 insurers.

Subjects were between the ages of 18-64 and had at least 1 diagnosis code for cirrhosis or portal hypertension (a common complication of cirrhosis). Enrollees were divided into 2 groups: AC and non-AC, the latter group being defined as having a non-alcohol-related cirrhosis code. Those who met the criteria for comorbid AC and hepatitis C or other liver diseases were included in the AC cohort.

Results showed an increase of all-cause cirrhosis by 42%, from 0.19% in 2009 to 0.27% (P < 0.001) in 2015. During the same time frame, AC increased by 43%, from 0.07% to 0.10% (P <0.001). In women, the increase was greater at 50%, going from 0.04% to 0.06%, while the increase was in men was less at 30% (0.10% - 0.13%).

At diagnosis, 19% of AC patients and 28% of non-AC patients had HCV. A higher percentage of patients in the AC group had decompensation (deterioration of liver function) compared to those with non-AC (28% versus 10%; P < 0.001). The AC group had more comorbidities at diagnosis (2.63% versus 2.30%; P <0.001).

Healthcare costs for all-cause cirrhosis for 2015 was $9.5 billion in the US, with 53% of those costs related to those with AC — even though those enrollees are just 36% of the total cirrhosis population. Per-person healthcare costs were high for AC, with a mean of $44,835 compared to $23,319 for non-AC.

Because of rising ALD and alcohol use disorder rates, Mellinger said health care providers to work on diagnosing patients before cirrhosis complications occur.

“The only treatment that is effective for these patients is alcohol cessation, so it’s critical to establish partnerships between hepatology, psychiatry, and addiction treatment professionals,” Mellinger said.

Mellinger added that additional studies need to focus on facilitating earlier diagnosis in the course of ALD, particularly on establishing the best ways to use alcohol biomarkers (blood and urine tests that can detect alcohol use), determining what alcohol use treatments work best in patients with AC, and evaluating how to integrate alcohol use treatment and hepatology care.

The study, “The high burden of alcoholic cirrhosis in privately insured persons in the United States,” was published online in Hepatology.