Alcoholic cirrhosis (AC) is a major cause of liver-related morbidity and mortality in the United States (US). Rising rates of alcohol use disorders in the US will likely result in more alcoholic liver disease. Our aim was to determine the prevalence, healthcare utilization, and costs of AC among privately insured persons in the US.
We collected data from persons aged 18-64 with AC (identified by ICD-9/ICD-10 codes) enrolled in the Truven MarketScan Commercial Claims and Encounters database (2009-2015). We determined yearly prevalence, weighted to the national employer-sponsored, privately insured population. Using competing risk analysis, we estimated event rates for portal hypertensive complications and estimated the association between alcoholic cirrhosis and costs as well as admissions and readmissions.
294,215 people had cirrhosis in 2015 and 105,871 (36%) had AC. Mean age at AC diagnosis was 53.5 years. 32% were women. Over the 7 years queried, estimated national cirrhosis prevalence rose from 0.19% to 0.27% (p<0.001) and from 0.07% to 0.10% (p<0.001) for AC. Compared to non-AC, AC enrollees were significantly more likely to have portal hypertensive complications at diagnosis, and higher yearly cirrhosis and alcohol-related admissions (25 excess cirrhosis admissions and 6.3 excess alcohol-related admissions per 100 enrollees) as well as all-cause readmissions. Per-person costs in the first year after diagnosis nearly doubled for AC versus non-AC persons (US$44,835 vs 23,319).
In a nationally representative cohort of privately insured persons, AC enrollees were disproportionately sicker at presentation, admitted and readmitted more often, and incurred nearly double the per-person healthcare costs compared to those with non-AC. This article is protected by copyright. All rights reserved.