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Published on: December 15, 2023
Inpatient Cost Burdens of Treating Chronic Hepatitis B in US Hospitals: A Weighted Analysis of a National Database
David Uihwan Lee1, Kuntal Bhowmick2, Sindhura Kolachana3
1Division of Gastroenterology and Hepatology, University of Maryland, 22 S. Greene St, Baltimore, MD, 21201, USA. dlee4@som.umaryland.edu.
Insights
Inpatient costs for chronic hepatitis B (CHB) did not significantly increase overall. However, specific patient groups, including older adults and those with MASLD, face rising healthcare expenses, necessitating targeted interventions.
Area of Science:
- Hepatology
- Health Economics
- Public Health
Background:
- Chronic hepatitis B (CHB) poses a significant public health challenge.
- Understanding the economic burden of CHB inpatient care is crucial for resource allocation.
- Stratification by cirrhosis status and patient demographics can reveal cost drivers.
Purpose of the Study:
- To evaluate the inpatient cost burdens associated with chronic hepatitis B (CHB).
- To stratify CHB patients by the presence of cirrhosis.
- To analyze cost trends across patient demographics and medical characteristics.
Main Methods:
- Utilized the 2016-2019 National Inpatient Sample for CHB patient selection.
- Calculated weighted charge estimates, adjusted for inflation to 2016 USD.
- Analyzed three cohorts: composite CHB, CHB with cirrhosis, and CHB without cirrhosis.
Main Results:
- Total CHB hospitalization costs ranged from $603.82 to $809.01 million between 2016-2019.
- No significant overall cost trends were observed in the composite CHB population or cirrhosis cohorts.
- Rising costs were associated with patients >65 years, white race, Hispanic ethnicity, Medicare, and comorbid MASLD in non-cirrhosis patients.
Conclusions:
- Overall inpatient costs for CHB did not significantly increase, irrespective of cirrhosis.
- Specific demographic and comorbidity factors are linked to escalating costs.
- Optimized screening and vaccination strategies are essential to mitigate costs in vulnerable populations.
Background And Aims:
This study evaluates the cost burdens of inpatient care for chronic hepatitis B (CHB). We aimed to stratify the patients based on the presence of cirrhosis and conduct subgroup analyses on patient demographics and medical characteristics.
Methods:
The 2016-2019 National Inpatient Sample was used to select individuals diagnosed with CHB. The weighted charge estimates were derived and converted to admission costs, adjusting for inflation to the year 2016, and presented in United States Dollars. These adjusted values were stratified using select patient variables. To assess the goodness-of-fit for each trend, we graphed the data across the respective years, expressed in a chronological sequence with format (R2, p-value). Analysis of CHB patients was carried out in three groups: the composite CHB population, the subset of patients with cirrhosis, and the subset of patients without cirrhosis.
Results:
From 2016 to 2019, the total costs of hospitalizations in CHB patients were $603.82, $737.92, $758.29, and $809.01 million dollars from 2016 to 2019, respectively. We did not observe significant cost trends in the composite CHB population or in the cirrhosis and non-cirrhosis cohorts. However, we did find rising costs associated with age older than 65 (0.97, 0.02), white race (0.98, 0.01), Hispanic ethnicity (1.00, 0.001), and Medicare coverage (0.95, 0.02), the significance of which persisted regardless of the presence of cirrhosis. Additionally, inpatients without cirrhosis who had comorbid metabolic dysfunction-associated steatotic liver disease (MASLD) were also observed to have rising costs (0.96, 0.02).
Conclusions:
We did not find a significant increase in overall costs with CHB inpatients, regardless of the presence of cirrhosis. However, certain groups are more susceptible to escalating costs. Therefore, increased screening and nuanced vaccination planning must be optimized in order to prevent and mitigate these growing cost burdens on vulnerable populations.
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