Inpatient resource utilization, disease severity, mortality and insurance coverage for patients hospitalized for hepatitis C virus in the United States

Abstract

Although the incidence of new hepatitis C virus (HCV) infection has fallen, HCV-related complications are on the rise. Our aim was to assess and describe the 2005-2009 national inpatient mortality and resource utilization trends for patients with HCV. Data from the National Inpatient Sample (NIS) and the National Hospital Discharge Survey (NHDS) between 2005 and 2009 were analyzed. Included were all adult hospital discharges with HCV-related ICD-9 codes. Incremental hospital charge, in-hospital mortality and length of stay (LOS) were estimated using n = 1000 bootstrap replicates clustered by unique hospital identifier. A total of 123 939 (0.38%) discharges were related to HCV (primary or secondary diagnosis). In-hospital mortality increased from 1.7% (2005) to 2.6% (2009) (P < 0.001). Inflation-adjusted charges increased 2% annually from 2005 ($16 455 ± $570) to 2009 ($17 532 ± $1007, P = 0.029). This increase occurred despite the average LOS (5 days) and hospital costs ($6500) remaining stable while at the same time, hospital-to-hospital transfer admissions and disposition to home health care increased. HCV-related hepatocellular carcinoma predicted longer hospital stay and death; older age predicted death; and receiving more procedures predicted higher hospital costs. The percentage of patients with private insurance significantly decreased (4.7%), while government-sponsored insurance and uninsured increased by 2.5% and 2.1%, respectively (P < 0.05). Uninsured patients had a 49%-72% greater chance of dying during hospitalization than those with government-sponsored insurance. HCV-related inpatient mortality and resource utilization have increased. HCC was the largest predictor for mortality and resource utilization. These data are consistent with the rising clinical and societal burden of chronic hepatitis C in the United States.

Keywords: National Inpatient Sample; hepatitis C virus; outcomes.