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DDW 5/2016: Trends in Health Care Utilization for Hepatitis C Virus Infection in the United States: "HCV related Cirrhosis and HCC increased significantly..... Hepatitis C related hospitalizations and associated are increasing over the past 15 years"
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Reported by Jules Levin
DDW May 21-26 2016 San Diego, CA
Vaibhav Wadhwa1, Sushil Kumar Garg2, Rocio Lopez3, Nizar N. Zein3, KV Narayanan Menon3, Madhusudhan R. Sanaka3
1 Internal Medicine, Cleveland Clinic, Cleveland, Ohio, United States; 2 Internal Medicine, University of Minnesota, Minneapolis, Minnesota, United States; 3 Department of Gastroenterology & Hepatology, Cleveland Clinic, Cleveland, Ohio, United States
Abstract: BACKGROUND/AIM: Hepatitis C infection is a growing burden in United States. The aim of this study was to evaluate the current burden of hospitalizations due to hepatitis C viral infection (HCV).
METHODS: We analyzed the National Inpatient Sample Database (NIS) for all subjects in which Hepatitis C was the discharge diagnosis from 1998-2012. If a patient had a primary or secondary diagnosis of HCV infection (ICD-9-CM codes 070.41, 070.44, 070.51, 070.54, 070.70, 070.71), we defined the hospitalization as HCV-related. We then also queried the selected HCV patients for comorbidities of index such as Cirrhosis of the liver (571.5), Hepatocellular carcinoma (HCC) (155.0), Hepatic encephalopathy (572.2), Hepatorenal syndrome (572.4), variceal hemorrhage (456.0, 456.2), Spontaneous bacterial peritonitis (567.23), Cryoglobulinemia (273.2) and Glomerulonephritis (580.81). The NIS is the largest publicly available all-payer inpatient care database in the United States. It contains data from approximately 8 million hospital stays each year. The temporal trends in discharge rates, length of stay and hospital charges in subjects with HCV were assessed by polynomial regression. A modified Charlson Comorbidity Index (CCI) was calculated using the NIS Disease Severity Measure files.
RESULTS: In 1997, there were 134,161 hospitalizations with Hepatitis C as compared to 607,056 in 2012 (p<0.001, Figure 1). HCV admission rates increased by approximately 15% per year in the early years and then this increase has been reducing through the years and is close to 1.5-2% per year in the later years. In addition, hospital charges in HCV discharges have increased an average of $2182 per year (p<0.001) while length of stay has been decreasing by a very small amount each year. Also, in-hospital deaths in HCV admissions have been decreasing on average 4% per year (Figure 2). The number of HCV-related Cirrhosis admissions increased by 342% over the last 15 years. Similarly, HCV-related HCC admissions increased by 645% over the study period.
CONCLUSIONS: The number of inpatient discharges for Hepatitis C has significantly increased between 1998 and 2012 with much of the increment coming in the last 5 years. The cost associated with these admissions has also increased significantly. The in-patient mortality rate also decreased significantly over past 15 years. There has been a marked increase in HCV-related Cirrhosis and an even greater increase in HCV-related HCC admissions over the past 15 years.
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