Chronic hepatitis B (CHB) still affects over 2 million people in the US and the authors were interested in the annual CHB utilisation and costs by disease severity and payer type. They used the Commercial, Medicare and Medicaid databases between 2004–2015 to retrospectively identify adults with CHB, and analyse all-cause inpatient, outpatient and pharmaceutical utilisation and costs by disease severity. The authors identified 33,904 CHB cases and 86,072 non-CHB controls. The all-cause inpatient admissions (average stay 6-10 days) were more frequent in advanced liver disease states. Across all payers, patients with decompensated cirrhosis had the highest emergency department utilisation (1.6-2.8 annual visits) and highest mean annual costs. The authors found that the largest all-cause cost components for Commercial and Medicaid were inpatient costs for all advanced liver disease groups (Commercial 62%, 47% and 68%; Medicaid 81%, 72% and 74%, for liver transplant, hepatocellular carcinoma and decompensated cirrhosis, respectively), and for the decompensated cirrhosis and hepatocellular carcinoma groups only for Medicare (49% and 48%, respectively). Patients with compensated liver disease were also found to incur costs that were threefold higher than non-CHB controls. Therefore patients with CHB with decompensated cirrhosis, hepatocellular carcinoma or a liver transplant incur the highest annual costs and utilisation of healthcare resources. However, even patients with compensated liver disease incur higher costs than those without.
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