Predictors of high healthcare resource utilization and liver disease progression among patients with chronic hepatitis C

Figures & data

Figure 1. Patient’s disposition. CHC, chronic hepatitis C.

Table 1. Demographic and clinical characteristics.

Outcomes	Overall population	Total healthcare costs*
	(n = 4898)	Remaining 80% with lowest costs	Top 20% costs
		(n = 3919)	(n = 979)
Demographics†
Age, mean (SD), years	52.4 (10.1)	52.5 (10.6)	52.1 (7.6)
Gender, female, n (%)	1928 (39.4%)	1534 (39.1%)	394 (40.2%)
Type of beneficiary,† n (%)
Employee	1505 (30.7%)	1255 (32.0%)	250 (25.5%)
Spouse/dependent/retiree	3393 (69.3%)	2664 (68.0%)	729 (74.5%)
Spouse	1527 (31.2%)	1163 (29.7%)	364 (37.2%)
Dependent	893 (18.2%)	729 (18.6%)	164 (16.8%)
Retiree	973 (19.9%)	772 (19.7%)	201 (20.5%)
Region,† n (%)
Northeast	689 (14.1%)	545 (13.9%)	144 (14.7%)
Midwest	816 (16.7%)	621 (15.8%)	195 (19.9%)
South	2139 (43.7%)	1746 (44.6%)	393 (40.1%)
West	780 (15.9%)	637 (16.3%)	143 (14.6%)
Unknown	474 (9.7%)	370 (9.4%)	104 (10.6%)
Insurance,† n (%)
HMO	579 (11.8%)	479 (12.2%)	100 (10.2%)
POS	713 (14.6%)	546 (13.9%)	167 (17.1%)
PPO	2364 (48.3%)	1888 (48.2%)	476 (48.6%)
Indemnity	1063 (21.7%)	864 (22.0%)	199 (20.3%)
Unknown	179 (3.7%)	142 (3.6%)	37 (3.8%)
Quan-Charlson comorbidity index,‡,$ mean (SD)	0.50 (1.18)	0.42 (1.05)	0.83 (1.58)
Liver disease severity at baseline$
Non-cirrhotic	4676 (95.5%)	3794 (96.8%)	882 (90.1%)
Compensated cirrhotic	80 (1.6%)	50 (1.3%)	30 (3.1%)
End-stage liver disease	142 (2.9%)	75 (1.9%)	67 (6.8%)
HCC	5 (0.1%)	4 (0.1%)	1 (0.1%)
Non-HCC	137 (2.8%)	71 (1.8%)	66 (6.7%)
CHC treatment at baseline$
Interferon therapy	176 (3.6%)	131 (3.3%)	45 (4.6%)
Comorbidities and conditions at baseline,$ n (%)
CHC-related
0	3287 (67.1%)	2770 (70.7%)	517 (52.8%)
1	1145 (23.4%)	850 (21.7%)	295 (30.1%)
≥2	466 (9.5%)	299 (7.6%)	167 (17.1%)
Non-CHC-related
0	4233 (86.4%)	3465 (88.4%)	768 (78.4%)
1	533 (10.9%)	376 (9.6%)	157 (16.0%)
≥2	132 (2.7%)	78 (2.0%)	54 (5.5%)
Detailed comorbidities and conditions at baseline,$ n (%)
CHC-related
Diabetes	592 (12.1%)	416 (10.6%)	176 (18.0%)
Psychiatric disease	425 (8.7%)	306 (7.8%)	119 (12.2%)
Depression	367 (7.5%)	252 (6.4%)	115 (11.7%)
Anemia	324 (6.6%)	203 (5.2%)	121 (12.4%)
Substance abuse	253 (5.2%)	188 (4.8%)	65 (6.6%)
Renal failure	133 (2.7%)	69 (1.8%)	64 (6.5%)
Bipolar	71 (1.4%)	43 (1.1%)	28 (2.9%)
Psoriasis	37 (0.8%)	22 (0.6%)	15 (1.5%)
Non-Hodgkin’s lymphoma	33 (0.7%)	26 (0.7%)	7 (0.7%)
Dialysis	29 (0.6%)	9 (0.2%)	20 (2.0%)
Lichen planus	11 (0.2%)	9 (0.2%)	2 (0.2%)
Porphyria cutanea tarda	11 (0.2%)	9 (0.2%)	2 (0.2%)
Schizophrenia	9 (0.2%)	6 (0.2%)	3 (0.3%)
Vasculitis	5 (0.1%)	4 (0.1%)	1 (0.1%)
Non-CHC-related
Coronary artery disease	260 (5.3%)	175 (4.5%)	85 (8.7%)
COPD	219 (4.5%)	139 (3.5%)	80 (8.2%)
Autoimmune deficiency	89 (1.8%)	55 (1.4%)	34 (3.5%)
Rheumatoid arthritis	79 (1.6%)	53 (1.4%)	26 (2.7%)
Heart failure	77 (1.6%)	42 (1.1%)	35 (3.6%)
Pregnancy	57 (1.2%)	49 (1.3%)	8 (0.8%)
Epilepsy	30 (0.6%)	21 (0.5%)	9 (0.9%)
Kidney transplant	24 (0.5%)	11 (0.3%)	13 (1.3%)
Crohn’s disease	17 (0.3%)	11 (0.3%)	6 (0.6%)
Cardiac arrest	7 (0.1%)	5 (0.1%)	2 (0.2%)
Lung/heart transplant	6 (0.1%)	1 (0.0%)	5 (0.5%)
Autoimmune deficiency	89 (1.8%)	55 (1.4%)	34 (3.5%)
Rheumatoid arthritis	79 (1.6%)	53 (1.4%)	26 (2.7%)

SD, standard deviation; PPO, Preferred provider organization; HMO, Health maintenance organization; POS, Point-of-service; HCC, hepatocellular carcinoma; CHC, chronic hepatitis C; COPD, chronic obstructive pulmonary disease; ER, emergency room.

*Based on the 80th ($63,588) percentile evaluated during the 3-year follow-up.

†Evaluated at the index date.

‡Mild and severe liver diseases were excluded from the Quan-Charlson comorbidity index.

$Evaluated during the 6-month baseline period.

Figure 2. Development of (a) HCC ESLD, (b) non-HCC ESLD, and (c) compensated cirrhosis stratified by 6-month intervals over 36 months of follow-up. HCC: hepatocellular carcinoma; ESLD: end-stage liver disease.

Table 2. Predictors of high healthcare costs in patients with CHC.

Predictors* (Ref = 80% with lowest costs)	Odds ratio (95% CI)
	20% with highest total costs	20% with highest inpatient and outpatient/ER costs
Demographics
Age, years
<45	1.00	1.00
45–65	1.15 (1.02–1.29)†	1.21 (1.07–1.37)†
>65	0.40 (0.33–0.50)†	0.37 (0.30–0.47)†
Female	1.05 (0.97–1.15)	1.17 (1.08–1.28)†
Type of beneficiary
Employee	1.00	1.00
Spouse/dependent/retiree	1.19 (1.09–1.30)†	1.25 (1.14–1.37)†
Specialist visit
Rheumatologist	1.49 (1.16–1.93)†	1.21 (0.94–1.57)
Gastroenterologist	1.39 (1.29–1.49)†	1.29 (1.20–1.39)†
Liver disease severity
Non-cirrhotic	1.00	1.00
Compensated cirrhotic	1.39 (1.21–1.60)†	1.54 (1.33–1.77)†
End-stage liver disease
With HCC	8.16 (4.75–14.00)†	5.73 (3.43–9.57)†
Without HCC	3.07 (2.60–3.63)†	2.57 (2.19–3.01)†
Comorbidities and conditions
CHC-related
0	1.00	1.00
1	1.61 (1.48–1.74)†	1.67 (1.54–1.81)†
≥2	2.78 (2.48–3.12)†	2.92 (2.60–3.27)†
Non-CHC-related
0	1.00	1.00
1	1.78 (1.60–1.98)†	1.82 (1.65–2.02)†
≥2	2.19 (1.76–2.72)†	2.03 (1.67–2.48)†
CHC treatment
Interferon-based therapy	4.21 (3.85–4.62)†	0.86 (0.76–0.96)†

CHC, chronic hepatitis C; CI, confidence interval; ER, emergency room; HCC, hepatocellular carcinoma.

*Additional predictors not reported in this table include the following: type of insurance (i.e., health maintenance organization, point of service, preferred provider organization, and indemnity), region (i.e., Northeast, Midwest, South, and West), and index year (i.e., 2001–2013).

†Denotes statistical significance.

Figure 3. Predictors of patients with CHC being diagnosed with compensated cirrhosis or ESLD (n = 4676). CHC, chronic hepatitis C; ESLD, end-stage liver disease; CI, confidence interval. †Denotes statistical significance. *Additional predictors not reported include the following: age group (i.e., ≤45, 45–65, >65 years), female, type of beneficiary, type of insurance (i.e., health maintenance organization, point of service, preferred provider organization, indemnity), region (i.e., Northeast, Midwest, South, and West), and the index year (i.e., 2001–2013).

Criteria for assignment to liver disease severity groups.

Liver disease severity group^a	Conditions or procedures*^,†	Type of code	List of codes
Non-cirrhosis HCV	No listed conditions or procedures
Compensated cirrhosis	Cirrhosis	ICD-9-CM	571.2x, 571.5x, 571.6x
Non-HCC ESLD	Hepatocellular carcinoma	ICD-9-CM	155.0x
	Liver transplant	ICD-9-CM	996.82, V42.7, 50.5x
		CPT	00796, 47135, 47136
	Liver failure, including hepatorenal syndrome	ICD-9-CM	572.0x, 572.1x, 572.4x
	Hepatic encephalopathy	ICD-9-CM	572.2x
	Portal hypertension	ICD-9-CM	572.3x
	Esophageal varices	ICD-9-CM	456.0x – 456.2x
	Other gastrointestinal hemorrhage	ICD-9-CM	578.xx
	Ascites	ICD-9-CM	789.5x
	Other sequelae of chronic liver disease	ICD-9-CM	572.8x
	Abdominal paracentesis procedures	ICD-9-CM	54.91
		CPT	49080, 49081
	Shunts and catheter procedures	ICD-9-CM	39.1x
	Treatment of varices	ICD-9-CM	42.33, 42.91, 43.41, 44.91
	Portal decompression procedures	CPT	37140–37183

HCV, hepatitis c virus; ICD-9-CM, International Classification of Diseases, ninth revision, clinical modification; CPT, current procedural terminology.

*As defined in Gordon et al.15.

†Assignment to a liver disease severity group was based on diagnosis or procedure codes. Patients were categorized according to the most severe liver condition observed during the study. HCC: Hepatocellular carninoma; ESLD: End-stage liver disease

Predictors of high healthcare costs in patients below 65 years of age with CHC.

Predictors* (Ref = 80% with lowest costs)	Odds ratio (95% CI)
	20% with highest total costs	20% with highest inpatient and outpatient/ER costs
Demographics
Age, years
<45	1.00	1.00
45–65	1.13 (1.00–1.27)	1.22 (1.08–1.38)†
Female	1.08 (0.99–1.18)	1.20 (1.10–1.31)†
Type of beneficiary
Employee	1.00	1.00
Spouse/dependent/retiree	1.18 (1.08–1.29)†	1.25 (1.14–1.37)†
Specialist visit
Rheumatologist	1.37 (1.02–1.83)†	1.18 (0.90–1.55)
Gastroenterologist	1.41 (1.30–1.52)†	1.29 (1.19–1.40)†
Liver disease severity
Non-cirrhotic	1.00	1.00
Compensated cirrhotic	1.43 (1.23–1.67)†	1.57 (1.35–1.83)†
End-stage liver disease
HCC	11.77 (5.78–23.97)†	6.90 (3.60–13.22)†
Non-HCC	2.96 (2.48–3.55)†	2.69 (2.26–3.20)†
Comorbidities or conditions
CHC-related
0	1.00	1.00
1	1.59 (1.46–1.73)†	1.69 (1.55–1.83)†
≥2	2.70 (2.39–3.05)†	2.83 (2.52–3.19)†
Non-CHC-related
0	1.00	1.00
1	1.77 (1.58–1.98)†	1.83 (1.64–2.04)†
≥2	2.54 (2.00–3.23)†	2.17 (1.73–2.71)†
CHC treatment
Interferon-based therapy	4.03 (3.67–4.42)†	0.84 (0.75–0.95)†

CHC, chronic hepatitis C; CI, confidence interval; ER, emergency room; HCC, hepatocellular carcinoma.

*Additional predictors not reported in this table include the following: type of insurance (i.e., health maintenance organization, point of service, preferred provider organization, and indemnity), region (i.e., Northeast, Midwest, South, and West), and index year (i.e., 2001–2013).

†Denotes statistical significance.

Gordon SC, Pockros PJ, Terrault N, et al. Impact of disease severity on healthcare costs in patients with chronic hepatitis C (CHC) virus infection. Hepatology (Baltimore, MD) 2012;56:1651-60

 PubMed Web of Science ®Google Scholar