Wong Robert J, Gagnon-Sanschagrin Patrick, Heimanson Zeev, Maitland Jessica, Bellefleur Remi, Guérin Annie, Samson Aaron, Olujohungbe Olamide, Bumpass Brock
Gastroenterology and Hepatology Section, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.
Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California, USA.
Clin Transl Gastroenterol. 2025 Jan 21;16(5). doi: 10.14309/ctg.0000000000000823.
Describing cirrhosis and hepatic encephalopathy (HE) burden over time can inform clinical management and resource allocation. Using healthcare claims data, this observational study examined recent trends in the prevalence of cirrhosis and HE and associated healthcare resource utilization among commercially and Medicare-insured adults in the United States.
Data from the MarketScan Commercial Claims and Encounters Database and 100% Medicare Research Identifiable Files were analyzed (2007-2020). Annual prevalence of cirrhosis, HE, overt HE (OHE) hospitalizations, and rifaximin ± lactulose use, and costs per hospitalization per year were calculated. Average year-over-year changes in prevalence of cirrhosis, and HE were estimated. Trends were extrapolated to 2030 using ordinary least-squares regression.
From 2007 to 2020, the prevalence of cirrhosis increased by an average of 4.6% year-over-year in the Commercial population and 8.1% in the Medicare population; the prevalence of HE increased by 4.3% and 2.5%, respectively. Rates of OHE hospitalizations decreased from 27.5% to 5.5% (Commercial) and from 26.2% to 9.5% (Medicare), and rates of liver transplantation increased. Average payer costs (Commercial) and provider charges (Medicare) per OHE hospitalization increased (from $40,881 to $77,699 and from $45,913 to $74,894, respectively). Use of rifaximin ± lactulose showed an increasing trend during the observation period, whereas lactulose use declined steadily.
The healthcare burden of cirrhosis and HE in the United States is increasing. Trends are projected to continue unless action is taken, such as improving medication access and developing policies addressing the contributing factors.
描述肝硬化和肝性脑病（HE）随时间的负担情况可为临床管理和资源分配提供依据。本观察性研究利用医疗保健理赔数据，调查了美国商业保险和医疗保险覆盖的成年人中肝硬化和HE患病率的近期趋势以及相关医疗资源利用情况。
分析了MarketScan商业理赔与诊疗数据库以及100%医疗保险研究识别文件中的数据（2007 - 2020年）。计算了肝硬化、HE、显性HE（OHE）住院率、利福昔明±乳果糖的使用情况以及每年每次住院费用。估算了肝硬化和HE患病率的年平均变化。使用普通最小二乘法回归将趋势外推至2030年。
2007年至2020年，商业保险人群中肝硬化患病率年平均增长4.6%，医疗保险人群中增长8.1%；HE患病率分别增长4.3%和2.5%。OHE住院率从27.5%降至5.5%（商业保险），从26.2%降至9.5%（医疗保险），肝移植率上升。每次OHE住院的平均支付方成本（商业保险）和医疗机构收费（医疗保险）均有所增加（分别从40,881美元增至77,699美元和从45,913美元增至74,894美元）。在观察期内，利福昔明±乳果糖的使用呈上升趋势，而乳果糖的使用则稳步下降。
美国肝硬化和HE的医疗负担正在增加。预计这种趋势将持续，除非采取行动，如改善药物可及性并制定应对相关影响因素的政策。
