INCREMENTAL HEALTHCARE COSTS ASSOCIATED WITH DECOMPENSATION EVENTS AMONG PATIENTS WITH CIRRHOSIS IN THE UNITED STATES
Author(s)
Arun B Jesudian, MD1, Arthur Voegel, MA2, Mohira Levesque-Leroux, MSc3, Nicole Hood, PhD2, Rashi Sharma, MSc3, Patrick Gagnon-Sanschagrin, MSc3, Annie Guerin, MSc3, Olamide Olujohungbe, PharmD4, Leonardo Passos Chaves, MD4.
1Weill Cornell Medicine, New York, NY, USA, 2Analysis Group Inc, New York, NY, USA, 3Analysis Group ULC, Montreal, QC, Canada, 4Bausch Health, Bridgewater, NJ, USA.
1Weill Cornell Medicine, New York, NY, USA, 2Analysis Group Inc, New York, NY, USA, 3Analysis Group ULC, Montreal, QC, Canada, 4Bausch Health, Bridgewater, NJ, USA.
OBJECTIVES: Decompensation events occur frequently in patients with cirrhosis, this study aimed to quantify the associated incremental healthcare costs.
METHODS: Adult patients with decompensated cirrhosis (diagnosis of ascites, hepatic encephalopathy [HE], or varices with bleeding [hereafter, “varices”] ≥90 days after first cirrhosis diagnosis) were identified in the Komodo Research Database (01/01/2016-11/30/2024). The index date was the first decompensation event. Continuous enrollment was required during the 12 months pre-index until the end of follow-up (earliest of end of enrollment, death, or data cutoff). All‑cause healthcare costs (2025 USD) post‑decompensation (by month) were compared with pre-decompensation “steady state” monthly costs (Months -12 to -4 pre-index, restricted to months after cirrhosis diagnosis), using a fixed‑effects panel regression, stratified by payer and index decompensation, and reported as cumulative incremental costs over a 12-month period.
RESULTS: Among 46,351 patients (mean age 63.5 years; 56.0% male; index decompensation event: 60.3% ascites, 26.1% HE, 13.5% varices), 41.6% were commercially insured, 40.5% Medicare, and 17.9% Medicaid. Relative to the steady state, commercially insured patients incurred significant incremental costs associated with their first decompensation throughout follow-up (p<0.01 for each post-decompensation month). Incremental monthly costs peaked in the first month post-decompensation (by decompensation: ascites [$22,466]; HE [$23,264]; varices [$20,983]), then declined gradually remaining elevated (Month 12: ascites [$4,978]; HE [$4,509]; varices [$1,870]) compared to pre-index monthly costs. Over the 12-month post-decompensation period, statistically significant incremental costs totaled $81,583 for ascites, $70,333 for HE, and $42,912 for varices. In the Medicare and Medicaid samples, the corresponding totals were $32,607 and $34,449 for ascites, $29,213 and $40,806 for HE, and $21,640 and $21,673 for varices, respectively.
CONCLUSIONS: These findings highlight the substantial and enduring economic burden of decompensated cirrhosis, especially in patients with HE and ascites. Persistently elevated post-decompensation costs emphasize the critical importance of preventing such events.
METHODS: Adult patients with decompensated cirrhosis (diagnosis of ascites, hepatic encephalopathy [HE], or varices with bleeding [hereafter, “varices”] ≥90 days after first cirrhosis diagnosis) were identified in the Komodo Research Database (01/01/2016-11/30/2024). The index date was the first decompensation event. Continuous enrollment was required during the 12 months pre-index until the end of follow-up (earliest of end of enrollment, death, or data cutoff). All‑cause healthcare costs (2025 USD) post‑decompensation (by month) were compared with pre-decompensation “steady state” monthly costs (Months -12 to -4 pre-index, restricted to months after cirrhosis diagnosis), using a fixed‑effects panel regression, stratified by payer and index decompensation, and reported as cumulative incremental costs over a 12-month period.
RESULTS: Among 46,351 patients (mean age 63.5 years; 56.0% male; index decompensation event: 60.3% ascites, 26.1% HE, 13.5% varices), 41.6% were commercially insured, 40.5% Medicare, and 17.9% Medicaid. Relative to the steady state, commercially insured patients incurred significant incremental costs associated with their first decompensation throughout follow-up (p<0.01 for each post-decompensation month). Incremental monthly costs peaked in the first month post-decompensation (by decompensation: ascites [$22,466]; HE [$23,264]; varices [$20,983]), then declined gradually remaining elevated (Month 12: ascites [$4,978]; HE [$4,509]; varices [$1,870]) compared to pre-index monthly costs. Over the 12-month post-decompensation period, statistically significant incremental costs totaled $81,583 for ascites, $70,333 for HE, and $42,912 for varices. In the Medicare and Medicaid samples, the corresponding totals were $32,607 and $34,449 for ascites, $29,213 and $40,806 for HE, and $21,640 and $21,673 for varices, respectively.
CONCLUSIONS: These findings highlight the substantial and enduring economic burden of decompensated cirrhosis, especially in patients with HE and ascites. Persistently elevated post-decompensation costs emphasize the critical importance of preventing such events.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE332
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Gastrointestinal Disorders