The burden of hepatorenal syndrome among commercially-insured and medicare patients in the United States.

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The burden of hepatorenal syndrome among commercially-insured and medicare patients in the United States.

Curr Med Res Opin. 2017 May 16;:1-25

Authors: Rice JB, White AG, Galebach P, Korenblat KM, Wagh A, Lovelace B, Wan GJ, Jamil K

Abstract
BACKGROUND: This study evaluated the characteristics healthcare resource utilization (HCRU), and costs, from the payer perspective, of hepatorenal syndrome (HRS) patients covered by commercial and Medicare insurance. Mortality was assessed as a secondary outcome.
METHODS: Patients were identified from claims databases of commercially-insured (OptumHealth Care Solutions, Inc.) in 1998-2014 and Medicare beneficiaries in 2009-2013 (5% Standard Analytic Files). At the time of their first inpatient admission ("index date") with an HRS diagnosis (ICD-9 code 572.4), commercially-insured patients must be aged 18-64 and Medicare patients must be aged 65 and older.
RESULTS: 784 commercially-insured and 1061 Medicare HRS patients met the sample selection criteria. Patients were disproportionately male (commercial: 63.0%; Medicare: 57.9%) with a mean age of 54.1 among commercially-insured and 74.1 among Medicare patients. Within the first 30 days, the average hospital length-of-stay (LOS) was 12.3 days among commercially-insured and 10.8 days among Medicare patients. Based on Kaplan-Meier analyses, 36% of commercially-insured and 26% of Medicare patients were readmitted within the next 30 days. During follow-up, many patients received dialysis (commercial: 33.0%; Medicare: 22.1%) or liver transplant (commercial: 10.7%; Medicare: 1.6%). Average costs within the 90-day follow-up were $157,665 for commercially-insured and $48,322 for Medicare patients, with 68.3% and 78.3% of the costs incurred within the first 30 days, respectively. The primary cost driver was inpatient visits (commercial: 90.3% of costs; Medicare: 83.1% of costs), with differences between the populations consistent with lower mortality, higher dialysis rates, and higher transplant rates (both liver and kidney) among the commercially-insured. Using US population and prevalence statistics, these results suggest that HRS imposes an annual total direct medical cost burden of approximately $3.0-$3.8 billion to payers over the period.
CONCLUSIONS: HRS imposes a significant economic burden.

PMID: 28509578 [PubMed - as supplied by publisher]

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