(365) Mapping the Cirrhosis Journey: Cirrhosis Etiologies and Rates, Timing, and Cost of Complications in a US claims database

Background: : Cirrhosis is a progressive liver disease that can lead to serious complications and rising healthcare costs. As severity advances, patients face higher risk of complications, adding clinical and economic burden. Understanding the timing and costs of complications is critical for timely intervention and resource planning.

Objective: : To assess the clinical and economic burden of cirrhosis by evaluating complication patterns and all-cause healthcare costs across disease stages in a real-world U.S. population.

Methods: : This retrospective cohort study used Komodo Research Data (2016–2023) to identify adults newly diagnosed with cirrhosis. Patients were followed from the index date, defined as diagnosis or first complication (ascites, overt hepatic encephalopathy [OHE], or varices with/without bleeding) until the earliest of end of enrollment, liver transplant, secondary neoplasm of liver, death, or data cutoff. Complications were described overall and by etiology: alcohol-associated liver disease [ALD], metabolic dysfunction-associated steatohepatitis [MASH], viral hepatitis, or other. Time to first complication was estimated using Kaplan-Meier methods. All-cause healthcare costs (2024 USD) per patient per month (PPPM) were evaluated across six periods: at any time, pre-diagnosis, 3-month diagnostic work-up, stable disease, 3-month pre-complication, and up to 3-month post-complication.

Results: : Among 110,359 adults with cirrhosis (median age: 60; 55.5% male; 56.9% White, median follow-up: 23.5 months), cirrhosis was attributed to ALD in 34.7% of patients, MASH in 22.8%, viral hepatitis in 13.8%, and other in 28.8%. Within 36 months, 62.3% developed a complication, with the highest risk in ALD (84.6%) and the lowest in viral hepatitis (41.5%). The most common initial complication was ascites (63.6%), followed by varices without bleeding (27.2%), OHE (14.6%), and varices with bleeding (8.5%). Among 66,563 patients with complications, total cost PPPM was $5,597, compared to $2,808 for those without. In patients with complications, costs fluctuated over time; total cost PPPM was $2,606 pre-diagnosis, $5,483 during diagnostic work-up, $2,639 during the stable disease period, $4,818 pre-complication, and $12,695 post-complication.

Conclusions: : Complications are common within 3 years of cirrhosis diagnosis and are linked with higher healthcare costs. These findings highlight the need for early intervention and monitoring to reduce burden and improve outcomes. Patients who experience complications incur higher costs, with a marked increase following onset of complications.

Sponsorship:: Bausch Health