Chronic liver disease is the 12th leading cause of death in the U.S. but we don’t fully understand its comprehensive impact on healthcare spending and, more importantly, on a patient’s quality of life. Our team at Inova Fairfax Hospital in Falls Church, VA, set out to shed some light on these often overlooked but important outcomes for chronic liver disease. What we found was that patients with chronic liver disease have impaired quality of life, are overall more costly to treat than other people seeking care, and face significant obstacles leading a normal life.
What did we learn?
We shared our findings at Digestive Disease Week 2016, the world’s largest gathering of physicians and researchers in the fields of gastroenterology, hepatology, endoscopy, and gastrointestinal surgery.
We discovered that patients with chronic liver disease were twice as likely to have publicly sponsored insurance (33.7% vs. 16.2%) and have lower annual income ($31,556 vs. $39,609). We used 2004-2013 data from the Medical Expenditure Panel Survey (MEPS); you can read more about the study design here.
We also found that these individuals used the healthcare system more often and, therefore, had healthcare expenses that were more than three times that of individuals who did not have liver disease ($18,359 vs. $5,271). This may be partly due to patients with chronic liver disease reporting impaired health status and having components of metabolic syndrome, as well as cardiac and cardiovascular diseases, more often compared to individuals without chronic liver disease.
We saw that nearly three times as many patients with chronic liver disease said they experienced physical limitations (34.0% vs. 12.2%). Additionally, almost four times as many patients reported the inability to participate in activities related to work, home, and/or school (34.6% vs. 9.3%) and experienced limitations in their social activities (19.7% to 5.2%). They also indicated more psychologic distress and depressive symptoms. Even after accounting for socioeconomic factors and comorbidities, these differences between the two groups still persisted.
Digging further into the employment data, our team found that the few employed patients with chronic liver disease lost more days of work due to disability. However, most patients were less likely to be employed and were not working due to illness or disability, especially if they suffered from liver cancer. These results, combined with previous studies examining the clinical outcomes of patients with chronic liver disease, reinforces the belief that chronic liver disease has a major impact not only on clinical outcomes, but also affect healthcare costs for the patient and society.
The bottom line
Given today’s environment of resource limitations and focus on value-based, high-quality care, we must ensure we adequately deal with chronic liver disease. It’s important that efforts continue to ensure patients are screened to catch and treat liver disease earlier to reduce avoidable costs. From the patient perspective, there are many treatment options available that may help patients avoid unnecessary suffering and potential costs of more advanced liver disease.