Factors Associated With the Highest Costs Among US Adults With Primary Biliary Cholangitis
Author(s)
Robert J. Wong, MD1, Ira M. Jacobson, MD2, Robert G. Gish, MD3, Ela Fadli, MPH4, Gabriel Gomez Rey, MS4, Marvin Rock, MPH, DrPH4, Gary Leung, PhD4, Maria Agapova, PhD4, Chong H Kim, MPH, MS, PhD4.
1Stanford University School of Medicine, Stanford, CA, USA, 2New York University Grossman School of Medicine, New York, NY, USA, 3Hepatitis B Foundation, Doylestown, PA, USA, 4Gilead Sciences, Inc., Foster City, CA, USA.
1Stanford University School of Medicine, Stanford, CA, USA, 2New York University Grossman School of Medicine, New York, NY, USA, 3Hepatitis B Foundation, Doylestown, PA, USA, 4Gilead Sciences, Inc., Foster City, CA, USA.
OBJECTIVES: Primary biliary cholangitis (PBC) is a cholestatic liver disease characterised by progressive destruction of intrahepatic bile ducts. This study evaluated factors associated with the highest costs in PBC.
METHODS: This observational, retrospective cohort study used data from the US HealthVerity database between 01/01/2016-30/06/2024 to identify adults diagnosed with PBC (≥1 inpatient or ≥2 outpatient claims [≥30 days apart] with an ICD-10-CM code of K74.3) and continuous health plan enrolment for ≥12 months pre- and post-index (defined as date of first claim with PBC diagnosis). All-cause costs (in 2024 US dollars) were calculated using total allowable charges from medical and pharmacy claims. Multivariable logistic regression was used to evaluate demographic and clinical factors associated with patients in the upper quartile (UQ; top 25th percentile of costs) cohort vs those in the non-UQ (NUQ) cohort.
RESULTS: In total, 9134 patients were identified, with mean (SD) age of 57 (14) years; most were female (82%) and commercially insured (51%), with median (IQR) 1-year, all-cause costs of $10,319 ($4,031-$30,572). In the UQ cohort (n=2283), fewer were female (75%) or commercially insured (41%), with median (IQR) 1-year, all-cause costs of $63,686 ($42,938-$107,988). Presence of rheumatoid arthritis (RA; UQ=12%; NUQ=6%), inflammatory bowel disease (IBD; UQ=12%; NUQ=4%), liver transplantation (UQ=17%; NUQ=2%), cardiovascular disease (CVD; UQ=61%; NUQ=24%), anaemia (UQ=71%; NUQ=26%), and decompensated cirrhosis (UQ=63%; NUQ=17%) increased the odds of being in the UQ cohort by 154%, 130%, 107%, 104%, 104%, and 99%, respectively.
CONCLUSIONS: Among the demographic and clinical characteristics evaluated, comorbidities were most strongly associated with the highest costs in PBC, suggesting that opportunities to contain costs in PBC may include concurrent optimisation of PBC treatment with treatment of RA, IBD, CVD, and anaemia. Decompensated cirrhosis and liver transplantation emerged as costly consequences of PBC, highlighting the value of slowing disease progression.
METHODS: This observational, retrospective cohort study used data from the US HealthVerity database between 01/01/2016-30/06/2024 to identify adults diagnosed with PBC (≥1 inpatient or ≥2 outpatient claims [≥30 days apart] with an ICD-10-CM code of K74.3) and continuous health plan enrolment for ≥12 months pre- and post-index (defined as date of first claim with PBC diagnosis). All-cause costs (in 2024 US dollars) were calculated using total allowable charges from medical and pharmacy claims. Multivariable logistic regression was used to evaluate demographic and clinical factors associated with patients in the upper quartile (UQ; top 25th percentile of costs) cohort vs those in the non-UQ (NUQ) cohort.
RESULTS: In total, 9134 patients were identified, with mean (SD) age of 57 (14) years; most were female (82%) and commercially insured (51%), with median (IQR) 1-year, all-cause costs of $10,319 ($4,031-$30,572). In the UQ cohort (n=2283), fewer were female (75%) or commercially insured (41%), with median (IQR) 1-year, all-cause costs of $63,686 ($42,938-$107,988). Presence of rheumatoid arthritis (RA; UQ=12%; NUQ=6%), inflammatory bowel disease (IBD; UQ=12%; NUQ=4%), liver transplantation (UQ=17%; NUQ=2%), cardiovascular disease (CVD; UQ=61%; NUQ=24%), anaemia (UQ=71%; NUQ=26%), and decompensated cirrhosis (UQ=63%; NUQ=17%) increased the odds of being in the UQ cohort by 154%, 130%, 107%, 104%, 104%, and 99%, respectively.
CONCLUSIONS: Among the demographic and clinical characteristics evaluated, comorbidities were most strongly associated with the highest costs in PBC, suggesting that opportunities to contain costs in PBC may include concurrent optimisation of PBC treatment with treatment of RA, IBD, CVD, and anaemia. Decompensated cirrhosis and liver transplantation emerged as costly consequences of PBC, highlighting the value of slowing disease progression.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE460
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Rare & Orphan Diseases