title: The inpatient economic and mortality impact of hepatocellular carcinoma from 2005 to 2009: analysis of the US nationwide inpatient sample.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) is an important complication of cirrhosis. Our aim was to assess the inpatient economic and mortality of HCC in the USA METHODS: Five cycles of Nationwide Inpatient Sample (NIS) conducted from 2005 to 2009 were used. Demographics, inpatient mortality, severity of illness, payer type, length of stay (LoS) and charges were available. Changes and associated factors related to inpatient HCC were assessed using simple linear regression. Odds ratios and 95% CIs for hospital mortality were analysed using log-linked regression model. To estimate the sampling variances for complex survey data, we used Taylor series approach. SAS(®) v.9.3 was used for statistical analysis.
  
  
  RESULTS
  From 2005 to 2009, 32,697,993 inpatient cases were reported to NIS. During these 5 years, primary diagnosis of HCC increased from 4401 (2005), 4170 (2006), 5065 (2007), 6540 (2008) to 6364 (2009). HCC as any diagnosis increased from 68 per 100,000 discharges (2005) to 99 per 100,000 (2009). However, inpatient mortality associated with HCC decreased from 12% (2005) to 10% (2009) (P < 0.046) and LoS remained stable. However, median inflation-adjusted charges at the time of discharge increased from $29,466 per case (2005) to $31,656 per case (2009). Total national HCC charges rose from $1.0 billion (2005) to $2.0 billion (2009). In multivariate analysis, hospital characteristic was independently associated with decreasing in-hospital mortality (all P < 0.05). Liver transplantation for HCC was the main contributor to high inpatient charges. Longer LoS and other procedures also contributed to higher inpatient charges.
  
  
  CONCLUSIONS
  There is an increase in the number of inpatient cases of HCC. Although inpatient mortality is decreasing and the LoS is stable, the inpatient charges associated with HCC continue to increase.
authors.affiliation: Center for Liver Disease, Inova Health System, Falls Church, VA, USA.
authors.forename: Alita
authors.initials: A
authors.lastname: Mishra
authors.forename: Munkhzul
authors.initials: M
authors.lastname: Otgonsuren
authors.forename: Chapy
authors.initials: C
authors.lastname: Venkatesan
authors.forename: Mariam
authors.initials: M
authors.lastname: Afendy
authors.forename: Madeline
authors.initials: M
authors.lastname: Erario
authors.forename: Zobair M
authors.initials: ZM
authors.lastname: Younossi
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000191:economics* / Q000401:mortality* / Q000628:therapy; D005260:Female; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000191:economics; D016014:Linear Models; D008113:Liver Neoplasms / Q000191:economics* / Q000401:mortality* / Q000628:therapy; D016031:Liver Transplantation / Q000191:economics / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010351:Patient Discharge / Q000191:economics; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: HCC; NIS; mortality; resource; utilization