Economic Burden of Primary Biliary Cholangitis by Line of Therapy in the United States

Lack of or delayed treatment of primary biliary cholangitis (PBC) is associated with worsening outcomes. This study assessed the real-world healthcare resource use (HRU) and costs of PBC in the USA to understand its economic burden by line of therapy.

This retrospective study analyzed IQVIA PharMetrics^® Plus claims data (2016-2022) for three non-mutually exclusive cohorts of adults diagnosed with PBC from January 1, 2017: untreated; first-line (1L) treatment with ursodeoxycholic acid (UDCA); second-line or more (2L+) treatment after UDCA. Index date for each cohort was: untreated, date of PBC diagnosis; 1L, 1L treatment initiation; 2L+, 2L treatment initiation. All-cause per-patient per-year (PPPY) HRU and costs during baseline and follow-up periods were compared among groups.

Patients in the untreated cohort had higher mean inpatient (IP) admissions (PPPY; 0.93 visits) and longer mean IP length of stay (LOS) (PPPY; 7.45 days) than the 1L (0.16 visits; 1.12 days) and 2L+ (0.19 visits; 1.77 days) cohorts during follow-up. Patients in the untreated cohort had the highest mean IP costs during the follow-up period (untreated: $37,974; 1L: $5854; 2L+: $6898). Compared with baseline, significantly higher HRU during follow-up was observed for the 1L and 2L+ cohorts regarding mean number of outpatient visits (incidence rate ratio [IRR]: 1.07; p = 0.001) and mean IP LOS (IRR: 2.12; p = 0.001), respectively.

These results highlight the importance of initiating timely treatment for PBC to reduce HRU and medical costs. The findings also demonstrate the need for novel, more effective PBC treatments.