The burden of hepatorenal syndrome among commercially insured and Medicare patients in the United States

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 patients (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: A total of 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. 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.

Keywords:

• Hepatorenal syndrome
• burden
• payer burden
• administrative claims

Transparency

Declaration of funding

This study was funded by Mallinckrodt Pharmaceuticals Inc., Hampton, NJ, USA.

Declaration of financial/other relationships

B.L., G.J.W. and K.J. have disclosed that they are employees of Mallinckrodt Pharmaceuticals, which provided research funding to Analysis Group Inc. J.B.R., A.G.W., A.W., and P.G. have disclosed that they are employees of Analysis Group Inc. K.M.K. has disclosed that he has no significant relationships with or financial interests in any commercial companies related to this study or article.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

No assistance in the preparation of this article is to be declared. Abstracts containing results from this analysis were presented at AASLD, Boston, MA, USA, 11–15 November 2016; and ASN, Chicago, IL, USA 15–20 November 2016.