Severe Alcohol-Associated Hepatitis Raises Health Care Costs Across Multiple Care Settings
Key Takeaways:
- Alcohol-associated hepatitis (AH) significantly increases care costs across different settings: After a diagnosis of AH, average care costs increased by 14% in outpatient settings, 266% in emergency department settings, and 413% in inpatient settings.
- Patients with AH also tend to have comorbidities: Hypertension, mental health disorders, liver disease, cirrhosis, and liver failure are some of the comorbidities associated with AH.
- Comorbidities drive health care costs: Severe comorbidities increase care costs as they require more intense treatment and monitoring and often result in hospitalization, which is why inpatient settings had the highest short-term care costs for AH.
AH, a severe type of alcohol-associated liver disease (ALD), has high rates of mortality and health care costs. While the long-term costs of AH have been well-documented, not many studies have evaluated the immediate costs following an AH diagnosis. This study assessed the short-term care costs for AH across different care settings and examined how comorbidities impacted health care costs.
Analyzing data from Optum’s Clinformatics Data Mart (CDM), this study identified 34 974 patients diagnosed with AH between January 2016 and September 2023. Of this sample size, 8048 (23%) patients were in outpatient settings, 2736 (7.8%) were in the emergency department (ED), and 24 190 (69.2%) were in inpatient settings. Health care costs for 30 days before and 30 days after AH diagnosis were estimated using 2023 cost values.
Study Findings
In the 30 days pre-AH diagnosis, average care costs were $7334 in outpatient settings, $5740 in ED, and $14 458 for inpatient settings. In the 30 days after an AH diagnosis, costs rose to $8345 for outpatient settings, $20 990 for ED, and $88 655 for inpatient settings. Care costs increased 14%, 266%, and 413%, respectively across the various settings.
Clusters of comorbidities contributed to the rise in costs. Most AH comorbidities were more common in inpatient settings compared to outpatient and ED settings. In the inpatient setting, the most common comorbidities included hypertension (62.8%), coagulopathy (43.6%), deficiency anemias (38.3%), moderate to severe liver disease (32.2%), neurological disorders (27.7%), and depression (24.3%).
The authors said, “Concurrent diagnoses of other ALD and complications related to AH, such as alcohol-associated fibrosis and sclerosis, cirrhosis, gastrointestinal bleeding, ascites, hepatic encephalopathy, and alcohol-associated hepatic failure, were associated with significantly increased care costs in hospitalized patients.” Among the patients hospitalized for AH, more than one third had liver cirrhosis as well, and 35% of these individuals experienced gastrointestinal bleeding.
Clinical Implications
This study’s findings illustrate that care costs are impacted by the severity of AH. Inpatient settings had the highest average cost, with ED the second highest, and outpatient settings last. The more aggressive the AH, as well as the more severe comorbidities, the more intense the treatment and the higher the likelihood of hospitalization.
This study provided insights into the economic effect of immediate care for AH on the health care system. Substantial costs highlight the need for targeted treatment and intervention, along with resource management strategies to mitigate the financial costs of AH while optimizing patient outcomes.
Reference
Nguyen CM, Su J, Li Y, et al. Short-term costs of alcohol-associated hepatitis care in different clinical settings. Hepatol Commun. 2025;9(2):e0634. doi:10.1097/HC9.0000000000000634
