EXCESS HEALTHCARE COSTS OF OVERT HEPATIC ENCEPHALOPATHY (OHE) RELATIVE TO NON-OHE CIRRHOSIS IN THE UNITED STATES
Author(s)
Arun B Jesudian, MD1, Debbie Goldschmidt, PhD2, Jérôme Bédard, MSc3, Tom Cornwall, PhD4, Sharat Shankar, MSc4, Patrick Gagnon-Sanschagrin, MSc3, Leonardo Passos Chaves, MD5, Olamide Olujohungbe, PharmD5, Annie Guerin, MSc3;
1Weill Cornell Medicine, New York, NY, USA, 2Analysis Group, Inc., New York, NY, USA, 3Analysis Group ULC, Montréal, QC, Canada, 4Analysis Group ULC, Toronto, ON, Canada, 5Bausch Health, Bridgewater, NJ, USA
1Weill Cornell Medicine, New York, NY, USA, 2Analysis Group, Inc., New York, NY, USA, 3Analysis Group ULC, Montréal, QC, Canada, 4Analysis Group ULC, Toronto, ON, Canada, 5Bausch Health, Bridgewater, NJ, USA
OBJECTIVES: OHE is a debilitating complication of cirrhosis that leads to recurrent hospitalizations and substantial healthcare utilization. This study quantified annual excess healthcare costs for patients with OHE relative to those with non-OHE cirrhosis in the United States.
METHODS: Adult patients with cirrhosis were identified in the Komodo Research Database (01/01/2016-06/30/2024) and stratified into OHE and non-OHE cirrhosis cohorts. Cohort assignment was determined by hospitalization with a primary diagnosis of HE. To estimate prevalent costs, the index date was randomly selected from all dates with ≥12 months of continuous enrollment thereafter, unless the patient died or underwent liver transplantation. Cohorts were reweighted using entropy balancing on age, sex, race/ethnicity, region, health plan, and index year. All-cause healthcare costs per-patient-per-year (2025 USD) were measured in the 12 months post-index.
RESULTS: The study included 31,120 OHE and 502,170 non-OHE cirrhosis patients. Weighted cohort characteristics were similar by design: median age of 59 years, 57.1% male, 66.4% White, 34.0% from the South and 39.3% covered by Medicare. Mean total healthcare costs were $78,301 in the OHE cohort and $46,184 in the non-OHE cirrhosis cohort (excess costs=$32,117). Medical costs represented 89.7% ($28,816) of this difference (OHE=$66,926, non-OHE cirrhosis=$38,110), while pharmacy costs accounted for 10.3% ($3,301; OHE=$11,375, non-OHE cirrhosis=$8,074). Excess costs were driven by inpatient costs (OHE=$46,245, non-OHE cirrhosis=$20,636), which represented 79.7% ($25,609) of the total difference. When extrapolated to the United States population level using an estimated 2024 OHE prevalence of 0.2% (N=585,711), these costs correspond to $18.8 billion in excess annual healthcare costs compared with non-OHE cirrhosis.
CONCLUSIONS: OHE is associated with substantially higher annual healthcare costs relative to non-OHE cirrhosis, largely driven by inpatient care. At the national level, this translates into a considerable economic burden, underscoring the importance of improving access to effective therapies aimed at preventing or slowing progression of cirrhosis.
METHODS: Adult patients with cirrhosis were identified in the Komodo Research Database (01/01/2016-06/30/2024) and stratified into OHE and non-OHE cirrhosis cohorts. Cohort assignment was determined by hospitalization with a primary diagnosis of HE. To estimate prevalent costs, the index date was randomly selected from all dates with ≥12 months of continuous enrollment thereafter, unless the patient died or underwent liver transplantation. Cohorts were reweighted using entropy balancing on age, sex, race/ethnicity, region, health plan, and index year. All-cause healthcare costs per-patient-per-year (2025 USD) were measured in the 12 months post-index.
RESULTS: The study included 31,120 OHE and 502,170 non-OHE cirrhosis patients. Weighted cohort characteristics were similar by design: median age of 59 years, 57.1% male, 66.4% White, 34.0% from the South and 39.3% covered by Medicare. Mean total healthcare costs were $78,301 in the OHE cohort and $46,184 in the non-OHE cirrhosis cohort (excess costs=$32,117). Medical costs represented 89.7% ($28,816) of this difference (OHE=$66,926, non-OHE cirrhosis=$38,110), while pharmacy costs accounted for 10.3% ($3,301; OHE=$11,375, non-OHE cirrhosis=$8,074). Excess costs were driven by inpatient costs (OHE=$46,245, non-OHE cirrhosis=$20,636), which represented 79.7% ($25,609) of the total difference. When extrapolated to the United States population level using an estimated 2024 OHE prevalence of 0.2% (N=585,711), these costs correspond to $18.8 billion in excess annual healthcare costs compared with non-OHE cirrhosis.
CONCLUSIONS: OHE is associated with substantially higher annual healthcare costs relative to non-OHE cirrhosis, largely driven by inpatient care. At the national level, this translates into a considerable economic burden, underscoring the importance of improving access to effective therapies aimed at preventing or slowing progression of cirrhosis.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE120
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Gastrointestinal Disorders, SDC: Neurological Disorders