The cost of dying of end-stage liver disease.
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.
Wong
L L
LL
Transplant Center, ST Francis Medical Center, University of Hawaii, Honolulu, USA.
McFall
P
P
Wong
L M
LM
D000328:Adult; D004932:Esophageal and Gastric Varices / Q000191:economics / Q000209:etiology / Q000628:therapy; D005260:Female; D017722:Hospital Charges; D006801:Humans; D007902:Length of Stay; D017093:Liver Failure / Q000150:complications / Q000191:economics* / Q000601:surgery / Q000628:therapy*; D016031:Liver Transplantation / Q000191:economics*; D008297:Male; D008875:Middle Aged; D011170:Portasystemic Shunt, Surgical / Q000191:economics*