title: The SCottish Alcoholic Liver disease Evaluation: A Population-Level Matched Cohort Study of Hospital-Based Costs, 1991-2011.
abstract: Studies assessing the costs of alcoholic liver disease are lacking. We aimed to calculate the costs of hospitalisations before and after diagnosis compared to population controls matched by age, sex and socio-economic deprivation. We aimed to use population level data to identify a cohort of individuals hospitalised for the first time with alcoholic liver disease in Scotland between 1991 and 2011.Incident cases were classified by disease severity, sex, age group, socio-economic deprivation and year of index admission. 5 matched controls for every incident case were identified from the Scottish population level primary care database. Hospital costs were calculated for both cases and controls using length of stay from morbidity records and hospital-specific daily rates by specialty. Remaining lifetime costs were estimated using parametric survival models and predicted annual costs. 35,208 incident alcoholic liver disease hospitalisations were identified. Mean annual hospital costs for cases were 2.3 times that of controls pre diagnosis (£804 higher) and 10.2 times (£12,774 higher) post diagnosis. Mean incident admission cost was £6,663. Remaining lifetime cost for a male, 50-59 years old, living in the most deprived area diagnosed with acoholic liver disease was estimated to be £65,999 higher than the matched controls (£12,474 for 7.43 years remaining life compared to £1,224 for 21.8 years). In Scotland, alcoholic liver disease diagnosis is associated with significant increases in admissions to hospital both before and after diagnosis. Our results provide robust population level estimates of costs of alcoholic liver disease for the purposes of health-care delivery, planning and future cost-effectiveness analyses.
authors: Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, United Kingdom.
authors: Janet
authors: J
authors: Bouttell
authors: Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, United Kingdom.
authors: James
authors: J
authors: Lewsey
authors: Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, United Kingdom.
authors: Claudia
authors: C
authors: Geue
authors: Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, United Kingdom.
authors: Grace
authors: G
authors: Antony
authors: Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, United Kingdom.
authors: Andrew
authors: A
authors: Briggs
authors: NHS Health Scotland, Glasgow, United Kingdom.
authors: Gerry
authors: G
authors: McCartney
authors: School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom.
authors: Sharon
authors: S
authors: Hutchinson
authors: Information Services Division, NHS National Services Scotland, Edinburgh, United Kingdom.
authors: Lesley
authors: L
authors: Graham
authors: Department of Gastroenterology, Royal Alexandra Hospital, Paisley, United Kingdom.
authors: Mathis
authors: M
authors: Heydtmann
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D017721:Hospital Costs; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008108:Liver Diseases, Alcoholic / Q000191:economics* / Q000453:epidemiology / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011320:Primary Health Care; D012606:Scotland / Q000453:epidemiology; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D015996:Survival Rate