OBJECTIVE: To determine the economic burden of liver cirrhosis, a common outcome of chronic hepatitis B, hepatitis C, and alcoholic liver disease. METHODS: Hospital inpatient admission records were analyzed for 1993-2001 in a health insurance claims database (MarketScan(r) Database) for 3.5-5.0 million employees enrolled annually. All patients > 18 years old admitted with a primary diagnosis of cirrhosis (ICD-9-CM code 571.2 or 571.5) were included in the analysis. For each patient identified, all admissions in a year were included except admissions related to hepatocellular carcinoma, liver transplantation, and admissions unlikely to be due to cirrhosis based on review of all primary and secondary diagnoses for each admission. Cost estimates were adjusted for inflation using the medical care component of consumer price index and are reported in 2002 US$. RESULTS: A total of 2073 cirrhosis patients with 4049 inpatient admissions were identified during the 9-year period. The average annual number of admissions per patient was 1.5 (95% confidence interval [CI]: 1.5-1.6); average length of hospital stay was 11.1 days (95% CI: 10.1-12.1), which decreased from 12.1 days in 1995 to 8.1 days in 2000. The annual cost of inpatient care per patient also decreased, from $31,244 in 1993 to $19,220 in 2000 for an average of $27,248 (95% CI: $24,247 - $30,250); 86% (95% CI: 84% - 87%) was for hospitalization and 7% (95% CI: 6% - 8%) for physician costs. CONCLUSIONS: Annual cost of inpatient care for liver cirrhosis in the United States is > $27,000 per patient hospitalized, more than twice the average annual cost for all hospital admissions (~ $12,000), and nearly seven times the per capita annual medical care expenses (~ $4,176). With > 25,000 annual deaths from cirrhosis, this causes substantial economic burden to society, and underscores the need to prevent development of cirrhosis by preventing hepatitis B, hepatitis C, and alcohol abuse.