# Cost of hepatic decompensation and liver transplantation events in primary biliary cholangitis: a retrospective observational study

## TL;DR

This study shows that liver complications and transplants in primary biliary cholangitis are very expensive for patients and healthcare systems.

## Contribution

The study provides a detailed cost analysis of hepatic decompensation and liver transplantation in primary biliary cholangitis using a large claims database.

## Key findings

- The average cost of hepatic decompensation hospitalization was $63,612.09.
- Liver transplantation averaged $328,336.60 per patient, with hospitalization being the most expensive part.
- Readmissions increased hepatic decompensation costs to $116,424.25 per event.

## Abstract

Complications of primary biliary cholangitis (PBC) are proposed to confer substantial economic burden to patients and healthcare systems. This retrospective observational study evaluated the cost of PBC-related hepatic decompensation and liver transplantation using a large administrative claims database.

Patients aged ≥18 years at the time of first claim with a diagnosis of PBC were identified using Optum’s de-identified Clinformatics® Data Mart Database. Two cohorts were established based on the type of event (hepatic decompensation or liver transplantation) that patients experienced on or after the date of their first claim with the PBC diagnosis. Costs for the hepatic decompensation hospitalization and 30-day post-discharge period were examined at the event level. Hospitalizations occurring within the 30-day post-discharge period after a hepatic decompensation event were considered readmissions, and costs from the initial event were combined with those from the ensuing readmissions. In the liver transplantation cohort, costs for the pretransplant evaluation, hospitalization for transplantation, and post-transplant care and complications were assessed per patient.

A total of 2118 and 163 patients met study inclusion criteria in the hepatic decompensation and liver transplantation cohorts, respectively. The overall mean cost per hepatic decompensation event (n = 3581) was $63,612.09. The mean cost per event with readmission within 30 days (n = 991, 27.7%) was $116,424.25; for events without readmission, the mean cost was $43,404.81. The mean total cost of liver transplantation per patient was $328,336.60. The mean cost per patient was highest for the hospitalization for transplantation ($226,908.70).

This comprehensive cost analysis demonstrates the high-cost burden of PBC disease progression. Appropriate patient management may help to mitigate the economic burden of PBC-related hepatic decompensation and liver transplantation.

Primary biliary cholangitis (PBC) is a chronic liver disease that will damage the liver over time, potentially leading to liver dysfunction (also called hepatic decompensation), liver failure requiring transplantation and death. This study evaluated the costs of PBC-related hepatic decompensation and liver transplantation in adult patients with PBC using a large national insurance claims database.

Costs for hepatic decompensation included costs from the hospitalization and 30-day period after discharge from the hospital. Costs for liver transplantation included a pretransplant evaluation, the hospitalization period and 1 year of post-transplant care, including the management of potential complications.

The average cost of a hospital stay for hepatic decompensation was $63,612.09. The average cost of a hospital stay was $116,424.25 when patients were readmitted to the hospital within 30 days after discharge (hospitalization costs for both stays combined). The average cost of liver transplantation per patient was $328,336.60. The hospitalization for transplantation was more expensive than the pretransplant evaluation or 1 year of post-transplant care.

The findings highlight the high cost burden associated with hepatic decompensation and liver transplantation. Use of current and emerging PBC therapies can potentially help reduce the risk for these events and avoid future associated costs.

This retrospective observational study using a large national claims database demonstrates that #primarybiliarycholangitis-related hepatic decompensation and liver transplantation are costly complications of disease progression for #patients and #healthcare systems