Health Economic Data on Burden of Hepatorenal Syndrome Published in Current Medical Research and Opinion
"HRS-related hospital admissions have risen over the past decade and have led to increased inpatient costs, yet understanding of the overall economic burden of this serious condition has remained limited," said study investigator
The retrospective study, titled "The burden of hepatorenal syndrome among commercially insured and
Anonymized claims from adults with HRS (18-64 years old) were identified from two HIPAA (the Health Insurance Portability and Accountability Act)-compliant claims databases of commercially insured patients (
The analysis suggests HRS poses a significant economic burden to payers estimated at
- A total of 784 commercially insured and 1061 Medicare HRS patients met the sample selection criteria.
- Patients were disproportionately male (commercial: 63.0 percent;
Medicare: 57.9 percent) with a mean age of 54.1 among commercially insured and 74.1 among Medicarepatients.
- Average HCRU during the 90-day outcome period was substantial for both commercially insured and
- Within the first 30 days, the average hospital length of stay was 12.3 days among commercially insured and 10.8 days among
- Based on Kaplan–Meier analyses, 36 percent of commercially insured and 26 percent of
Medicarepatients were readmitted within the next 30 days.
- Many patients received dialysis (commercial: 33.0 percent;
Medicare: 22.1 percent) or liver transplant (commercial: 10.7 percent; Medicare: 1.6 percent) during follow up.
- Median survival was 95 days among commercially insured patients and 33 days among
- Per patient healthcare costs were substantial for both commercially insured and Medicare HRS patients during the 90-day outcome period:
- Average costs were
$157,665for commercially insured and $48,322for Medicarepatients, with 68.3 percent and 78.3 percent of the costs incurred within the first 30 days.
- The primary cost driver was inpatient visits (commercial: 90.3 percent of costs;
Medicare: 83.1 percent of costs), with differences between the subpopulations consistent with lower mortality, higher dialysis rates, and higher liver and kidney transplant rates among the commercially insured.
"Liver transplant is the only definitive treatment for HRS, but not feasible in most cases due to organ availability and eligibility issues. Yet at present there are no approved drug therapies for HRS type 1 in the U.S. or
Terlipressin is being investigated in a Phase 3 clinical trial for the treatment of HRS type 1, an acute form of the condition. The safety and effectiveness of terlipressin has not been established with the
Limitations of the Study
- Limitations of the study include its reliance on the accuracy of diagnosis codes to identify patients with HRS, to evaluate their comorbidity profiles at baseline, and their HCRU during the outcome period.
- Diagnosis codes do not differentiate between HRS type 1 and HRS type 2, and accuracy of all codes may vary.
- The HCRU and cost findings may not be generalizable to other patients, such as those enrolled in
- The economic burden of HRS is likely underestimated as this study did not assess the longer- term economic burden of HRS, and cost estimates were not inflation adjusted over the study periods (1998-2014 for commercial and 2009-2013 for
About Hepatorenal Syndrome
HRS is characterized by rapid, progressive functional renal failure and has a very poor prognosis, with >80 percent mortality within three months. HRS is a rare syndrome of marked renal dysfunction in patients with cirrhosis, decompensated liver disease and portal hypertension. At present, there are no approved drug therapies for HRS type 1 in the U.S. or
Terlipressin is a synthetic vasopressin analogue being investigated for the treatment of HRS type 1 in the U.S. and
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4 Nadim, M., et al. Management of the critically ill patient with cirrhosis: A multidisciplinary perspective.
5 Angeli, P., et al. Diagnosis and management of acute kidney injury in patients with cirrhosis: Revised consensus recommendations of the
6 4 Nadim, M., et al. Hepatorenal syndrome: the 8th international consensus conference of the
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