Resource Utilization and Outcomes of Medicare Recipients With Chronic Hepatitis B in the United States

• Published in: Journal of clinical gastroenterology Vol. 53; no. 8; p. e341
• Main Authors: Kim, Min, Paik, James, Golabi, Pegah, Jeffers, Thomas, Mishra, Alita, Younossi, Zobair M
• Format: Journal Article
• Language: English
• Published: United States 01.09.2019
• ISSN: 1539-2031
• DOI: 10.1097/MCG.0000000000001110

To assess the outcomes and resource utilization of chronic hepatitis B (CH-B) among Medicare beneficiaries. CH-B is highly prevalent among immigrants from endemic areas. Although incidence of CH-B is stable in the United States, CH-B patients have become Medicare eligible. We used the inpatient and outpatient Medicare database (2005 to 2014). Adult patients with CH-B diagnosis were included. One-year mortality and resource utilization were assessed. Independent associations with resource utilization and mortality were determined using multivariate analysis. Study cohort included 18,603 Medicare recipients with CH-B. Between 2005 and 2014, number of Medicare beneficiaries with CH-B increased by 4.4% annually. The proportion of beneficiaries with CH-B who were whites decreased while those who were Asians increased (P<0.05). Furthermore, 7.4% of CH-B Medicare cohort experienced decompensated cirrhosis, 2.9% hepatocellular carcinoma (HCC) and 11.9% 1-year mortality. Although the number of inpatients with CH-B remained stable, the number of outpatient encounters increased. Annual total inpatient charges increased from $66,610 to $94,221 while these charges for outpatient increased from $9257 to $47,863. In multivariate analysis, age [odds ratio (OR), 1.05; 95% confidence interval (CI), 1.04-1.05], male gender [OR, 1.24 (95% CI, 1.12-1.38)], decompensated cirrhosis [OR, 3.02 (95% CI, 2.63-3.48)], HCC [OR, 2.64 (95% CI, 2.10-3.32)], and higher Charlson comorbidity index [OR, 1.24 (95% CI, 1.21-1.27)] were independently associated with increased 1-year mortality. HCC and higher Charlson comorbidity index were also associated with higher inpatient and outpatient charges, and inpatient length of stay (all P<0.001). CH-B infection has been rising in Medicare population and is responsible for significant mortality and resource utilization.