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Research Article
6 March 2025

Burden of illness for patients with primary biliary cholangitis: an observational study of clinical characteristics and healthcare resource utilization

Authors: Robert G Gish https://orcid.org/0000-0001-6306-3189, Joanna P MacEwan https://orcid.org/0000-0003-2702-1170 [email protected], Alina Levine, Dannielle Lebovitch https://orcid.org/0000-0002-7203-3878, Leona Bessonova, Darren Wheeler, Radhika Nair, and Alan Bonder https://orcid.org/0000-0001-6821-0416Author Info & Affiliations
Volume 14, Number 4
https://doi.org/10.57264/cer-2024-0174
PDFFormats

Abstract

Aim: To evaluate the clinical characteristics and healthcare resource utilization for acute care and its costs for patients with primary biliary cholangitis (PBC) with or without cirrhosis. Materials & methods: This retrospective observational cohort study was conducted using two datasets (Komodo’s Healthcare Map™ [Komodo Health] and Optum Clinformatics® Data Mart [CDM] database) between 2015 and 2023. Patients (≥18 years) with PBC were identified based on ≥1 inpatient or ≥2 outpatient claims. Healthcare resource utilization for acute care (hospitalizations and emergency department [ED] visits [not leading to hospitalization]) were assessed in both datasets, and associated medical costs were evaluated in Optum CDM. Results: In Komodo Health, of the 29,758 patients with PBC (mean age: 59.2 years), 21.6% had cirrhosis and 50.4% of patients with cirrhosis had Medicaid or Medicare coverage. Of the total 8143 patients in Optum CDM (mean age: 67.0 years), 20.7% had cirrhosis, and most were enrolled in Medicare (69.7%). There was a larger proportion of men in the cirrhosis group compared with the no-cirrhosis group in Komodo Health (31.7 vs 16.3%) and Optum CDM (29.7 vs 16.5%). Annually, among patients with cirrhosis who had a hospitalization, 69.3% had additional hospitalizations, and among patients who had an ED visit, 52.9% had additional ED visits in Komodo Health; similar results were observed in Optum CDM. Among patients with at least one acute-care event, the mean annual acute-care costs with and without cirrhosis were $113,568 and $47,436, respectively. Conclusion: Data from two large healthcare claims databases showed that the majority of patients who had at least one acute-care event experienced additional acute-care events, particularly among those with cirrhosis. Timely treatment to avoid hospitalization and disease progression may help mitigate the clinical and economic burden for patients with PBC.

Plain language summary: illness burden & costs with primary biliary cholangitis

What is this article about?

Primary biliary cholangitis (PBC) is a chronic liver disease that can worsen over time. Without effective treatment, PBC can cause serious health problems, including reduced quality of life, liver scarring (called cirrhosis), liver failure and death. People with PBC and cirrhosis tend to have other medical conditions and use more healthcare services than people without cirrhosis. In using two large national claims datasets, this study looked at how often healthcare services, especially hospitalizations and emergency department (ED) visits, are used and how much these services cost on an average for patients with PBC, with and without cirrhosis.

What were the results?

One in five patients diagnosed with PBC had cirrhosis, and patients with cirrhosis had more concomitant medical conditions. More than half of patients with cirrhosis who had at least one hospitalization or ED visit for any reason had additional acute-care visits (hospitalizations or ED visits) in the same year. For patients who were hospitalized or had ED visits, the average medical costs were more than double for patients with cirrhosis ($113,567.55) compared with those without cirrhosis ($47,435.95).

What do the results mean?

Patients who had one acute-care event (hospitalization or ED visit) had additional acute-care events, especially those who also had cirrhosis. Given the high use of healthcare services for advanced stages of PBC, timely treatment to avoid hospitalization and negative clinical outcomes is important.

Shareable abstract

Patients with untreated or unmanaged #primarybiliarycholangitis may develop #cirrhosis, which can lead to more hospital and emergency room visits. Early treatment leads to better #healthoutcomes and reduces #healthcarecosts.

Supplementary Material

File (supplementary data.docx)

References

Papers of special note have been highlighted as: • of interest
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