Obradović Filip, Vitello Dominic J, Hasjim Bima J, Obayemi Joy, Polineni Praneet, Gmeiner Michael, Koep Eleena, Jain Aditya, Crippa Federico, Duarte-Rojo Andrés, Rohan Vinayak S, Kulik Laura, Doll Julianna M, Banea Therese, McNatt Gwen E, Zhao Lihui, VanWagner Lisa B, Manski Charles F, Ladner Daniela P
Department of Economics, Northwestern University, Evanston, Illinois, USA.
Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Hepatology. 2025 Jan 6. doi: 10.1097/HEP.0000000000001206.
Cirrhosis prevalence is increasing, yet costs associated with its chronic, complex care are poorly understood. The aim was to characterize the costs of care for patients with cirrhosis and compare them to other chronic diseases such as heart failure (HF) and chronic obstructive pulmonary disease (COPD), for which the public health burden is better recognized.
Patients enrolled in Medicare Advantage plans from a large national insurer between 2011 and 2020 with cirrhosis, HF, and COPD were identified by ICD-9/-10 codes. Costs (USD) of care were calculated per patient-month and included inpatient medical, emergency medical, pharmacy, and other costs. In all, 93,308 patients with cirrhosis, 355,520 patients with HF, and 318,949 patients with COPD were analyzed. Patients with cirrhosis, HF, and COPD had a mean (SD) age of 69.6 (9.5), 75.9 (9.7), and 72.9 (9.8) years, respectively. The most frequent etiologies were metabolic dysfunction-associated steatohepatitis (37.7%) and alcohol-associated cirrhosis (22.1%). The total monthly cost of care for patients with cirrhosis, HF, and COPD was $3032.00, $2491.60, and $1955.60 respectively. The cost for patients with cirrhosis exceeded that for HF by $540.40 (21.7% higher) and COPD by $1076.30 (55.0% higher). The monthly cost of care for decompensated cirrhosis was $3969.30, which was 59.3% ($1477.70) higher than for HF and 103.0% ($1,955.60) higher than for COPD.
The cost of care for cirrhosis is high, significantly higher than HF and COPD. Interventions directed at optimizing care to prevent progression to cirrhosis and decompensation are likely to alleviate this public health burden.
肝硬化的患病率正在上升，但其慢性、复杂护理相关的费用却知之甚少。目的是描述肝硬化患者的护理费用，并将其与其他慢性疾病（如心力衰竭（HF）和慢性阻塞性肺疾病（COPD））进行比较，这些慢性疾病的公共卫生负担已得到更好的认识。
通过ICD - 9/-10编码确定2011年至2020年间参加一家大型全国性保险公司的医疗保险优势计划的肝硬化、HF和COPD患者。按患者每月计算护理费用（美元），包括住院医疗、急诊医疗、药房和其他费用。总共分析了93308例肝硬化患者、355520例HF患者和318949例COPD患者。肝硬化、HF和COPD患者的平均（标准差）年龄分别为69.6（9.5）岁、75.9（9.7）岁和72.9（9.8）岁。最常见的病因是代谢功能障碍相关脂肪性肝炎（37.7%）和酒精性肝硬化（22.1%）。肝硬化、HF和COPD患者每月的总护理费用分别为3032.00美元、2491.60美元和1955.60美元。肝硬化患者的费用比HF患者高出540.40美元（高21.7%），比COPD患者高出1076.30美元（高55.0%）。失代偿期肝硬化患者每月的护理费用为3969.30美元，比HF患者高59.3%（1477.70美元），比COPD患者高103.0%（1955.60美元）。
肝硬化的护理费用很高，显著高于HF和COPD。旨在优化护理以防止进展为肝硬化和失代偿的干预措施可能会减轻这一公共卫生负担。
