Hospitalization Patterns and Costs of Primary Biliary Cholangitis (PBC) in Germany

OBJECTIVES: Primary biliary cholangitis (PBC) is a rare chronic autoimmune liver disease characterized by progressive destruction of intrahepatic bile ducts leading to cirrhosis. Understanding the hospitalization patterns of patients with PBC is supporting optimization of treatment decisions and resource allocation. This study aimed to assess the demographic characteristics of hospitalizations of PBC patients in Germany.

METHODS: Inpatient care data from the Federal Statistical Office and quality reports from 2021 were examined and analyzed for PBC coding.

RESULTS: In 2021 there were 4,231 hospitalizations with PBC coded in Germany 1,057 as main diagnosis (MD) and 3,174 as secondary diagnosis (SD). Female patients were 80.5% (MD: 79.8%; SD: 80.8%). Average length of stay was 8.9d (MD: 8.1d; SD: 9.1d). Average age of patients was 65.6y (MD: 62.6y; SD: 66.6y). Stadium of cirrhosis was Child-Pugh A: 13.8%, B: 13.3%; C: 7.5%. Ascites was coded in 18.5% of cases (MD: 30.5%; SD: 14.6%), esophageal varicose with or without bleeding 23.5%, hepatic encephalopathy 3.8% and arterial hypertension: 32.8%. 218 patients died during hospitalization (5.2%). Female patients 73.4% (MD: 68.9%; SD 74.7%). Average age was 71.2y (MD: 68.3y; SD 72.0y). Average length of stay 19.6d. Stadium of cirrhosis was Child-Pugh A: 10.1%, B: 16.1%; C: 26.6%. Hospitalization costs by DRG billing were 15.5m€ (MD: 3.5m€; SD 12.0m€). The average case costs were 3.667€

CONCLUSIONS: PBC is a rare disease. Analysis of hospitalization patterns indicated that the most common side diagnoses among PBC patients were complications related to cirrhosis, including ascites, hepatic encephalopathy, and gastrointestinal bleeding. This confirms the high disease burdon and need for stage directed therapy, including medical treatment and transplant evaluation. More information could be gained by implementation of a registry.