Hospitalization costs associated with liver disease, liver cancer and liver transplants for patients infected with hepatitis B or hepatitis C, California 2010

Background: Hepatitis B (HBV) and hepatitis C (HCV) viruses are two of the world's most common and serious infectious diseases and place a significant burden on healthcare resources. Approximately 20% of HCV-infected and 15-40% of HBV-infected persons will develop liver cirrhosis, liver disease or hepatocellular carcinoma.

Methods: The California Office of Statewide Health Planning and Development Patient Discharge Database comprises records for each inpatient discharged from a California licensed hospital each year. The following ICD-9-CM diagnosis and procedure codes were used to identify patients in this dataset hospitalized with HBV (070.20-070.39, 070.42-070.42, 070.52) or HCV (070.70-070.79, 070.40, 07044, 07051, 07054) and with liver disease (570.00 - 573.99), liver cancer (155.00-156.99), or liver transplant (505.0-505.9). Total inpatient charges based on the hospital's full established rates of services rendered during the admission before contractual adjustments were calculated and stratified by payer.

Results: In 2010, there were more than 30,000 hospitalizations in California for liver disease, liver cancer, or liver transplant-related treatments in patients infected with HBV or HCV. Over $2.3 billion was charged for more than 206,000 hospitalization days, including >$819,000,000 charged to Medicare and >$821,000,000 charged to Medicaid. The majority of these costs ($2.1 billion) were related to patients infected with HCV.

Discussion: Liver disease, cancer and transplant-related hospitalization costs in California among patients infected with HBV or HCV are substantial. The majority of these costs are covered by tax-supported public health insurers. Patient screening and early treatments should be considered public health priorities to reduce end-stage liver disease complications related to these infectious diseases.