title: Chronic Hepatitis B Is Associated with Higher Inpatient Resource Utilization and Mortality Versus Chronic Hepatitis C.
abstract: Chronic hepatitis B virus (HBV) and chronic hepatitis C virus (HCV) infections remain one of the leading causes of chronic liver disease and hepatocellular carcinoma. Healthcare initiatives for chronic viral hepatitis to facilitate early diagnosis and linkage to care in an effort to reduce inpatient resource utilization associated with late diagnosis and end-stage liver disease have been partially successful.
  
  
  
  Our objective was to determine the impact of liver-related complications from chronic HBV and HCV infections on inpatient cost of care, length of stay, and mortality.
  
  
  
  Using the Healthcare Cost and Utilization Project, National Inpatient Sample (HCUP-NIS), we studied the impact of chronic HBV and HCV infections on inpatient healthcare system following hospitalizations from 2003 to 2012.
  
  
  
  Of the 79,185,729 million hospitalizations among adult patients in the USA from 2003 to 2012, 143,896 (0.18 %) hospitalizations were HBV related and 1,073,269 (1.36 %) hospitalizations HCV related. HBV hospitalizations had a higher inpatient mortality (OR 1.34; 95 % CI 1.30, 1.38), median cost of care per hospitalization (+$2100.33; 95 % CI 1982.53, 2217.53), and increased length of hospitalization stay (+0.64 days; 95 % CI 0.60, 0.68; p < 0.01) compared to HCV.
  
  
  
  Despite higher per case resource utilization following hospitalization, HBV-infected patients demonstrate a lower inpatient survival in comparison with chronic HCV infection. These disparate observations underscore the need for early diagnosis of chronic HBV infection in at-risk population and prompt linkage to care.
authors.affiliation: Department of Internal Medicine, Roger Williams Medical Center, Boston University School of Medicine, 825 Chalkstone Avenue, Providence, RI, 02908, USA. gcholankeril@gmail.com.
authors.forename: George
authors.initials: G
authors.lastname: Cholankeril
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, Grant S101, Stanford, CA, 94305, USA.
authors.forename: Ryan B
authors.initials: RB
authors.lastname: Perumpail
authors.affiliation: Department of Biostatistics, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA.
authors.forename: Menghan
authors.initials: M
authors.lastname: Hu
authors.affiliation: Department of Infectious Disease, Roger Williams Medical Center, Boston University School of Medicine, 825 Chalkstone Avenue, Providence, RI, 02908, USA.
authors.forename: Gail
authors.initials: G
authors.lastname: Skowron
authors.affiliation: Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, 3rd Floor Claude Moore Building, 3300 Gallows Road, Falls Church, VA, 22042, USA.|Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.
authors.forename: Zobair M
authors.initials: ZM
authors.lastname: Younossi
authors.affiliation: Department of Gastroenterology and Hepatology, Stanford University of School Medicine, 750 Welch Rd 210, Palo Alto, CA, 94304, USA.
authors.forename: Aijaz
authors.initials: A
authors.lastname: Ahmed
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D058625:End Stage Liver Disease; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D019694:Hepatitis B, Chronic / Q000191:economics* / Q000401:mortality; D019698:Hepatitis C, Chronic / Q000191:economics* / Q000401:mortality; D017721:Hospital Costs; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health; D007902:Length of Stay / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014481:United States
keywords: Chronic hepatitis B; Chronic hepatitis C; Healthcare utilization; Linkage to care