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July 14, 1997

The Cost of Dying of End-Stage Liver Disease

Author Affiliations

From the Transplant Center, St Francis Medical Center, and Department of Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu.

Arch Intern Med. 1997;157(13):1429-1432. doi:10.1001/archinte.1997.00440340047004

Background:  The high cost of liver transplantation is well known. The cost of dying of complications of end-stage liver disease (ESLD) without transplant, however, has not been well documented.

Methods:  For a 5-year period (1991-1995), in 153 patients, mean inpatient hospital charges and length of stay were analyzed in 6 groups of patients: (1) patients admitted with the primary diagnosis of esophageal varices, (1a) the subset of group 1 patients who died on this admission, (2) patients admitted to the liver team who died of complications from ESLD, (3) patients who underwent transjugular intrahepatic portosystemic shunts, (4) patients who underwent surgical shunt for bleeding varices, and (5) patients who underwent liver transplantation.

Results:  One hundred twenty-nine patients with esophageal varices were hospitalized 13.7 days with a mean charge of $30 980 for each of 202 admissions. Of these, 38 died after 24 days with a mean charge of $67 091. Seven patients admitted to the liver team died of complications of ESLD at $110 576 per admission. Transjugular intrahepatic portosystemic shunt was performed in 17 patients with a mean charge of $43 209. Six patients underwent surgical shunt for $53 994. Mean charge for 7 liver transplantations was $222 968. During the study period, 36.7% of all charges were for patients who died.

Conclusions:  It is difficult to estimate the total cost of ESLD; however, in evaluating inpatient costs, we see that it is expensive and significant amounts are spent on patients who die. Further study is necessary to determine which factors can optimize the cost of ESLD.Arch Intern Med. 1997;157:1429-1432