P3799 - Medicare Patients With Cirrhosis and Ascites Requiring Repeated Paracentesis Present Major Uncovered Hospital Costs

Jasmohan S.. Bajaj, MD, MS, FACG¹, Sammy Saab, MD, MPH², Gijs Klarenbeek, MD³, Stephen Hull, MHS⁴
1Virginia Commonwealth University; Central Virginia Veterans Healthcare System, Richmond, VA; 2David Geffen School of Medicine at UCLA, Los Angeles, CA; 3Sequana Medical, Hoegaarden, Vlaams-Brabant, Belgium; 4Avania Clinical LLC, Boston, MA

Introduction: The incidence of cirrhosis and ascites is increasing, especially in older adults. Cirrhosis-related ascites can require regular paracentesis if not adequately controlled with medications. To assess the economic burden of liver-related ascites, in this first of its kind analysis we examined hospital costs and Medicare payment for US original Medicare patients requiring regular paracentesis over a three-year interval, from 2017 to 2019, using the inpatient and outpatient Standard Analytic Files (SAF).

Methods: We identified 11,938 original Medicare patients in 2017 based on a combination of liver-related and ascites diagnosis codes, as well as at least three paracentesis procedures during the year. Hepatocellular cancer patients were excluded. Overall, the patient cohort experienced mortality of 70.1% over the three-year interval. In this study cohort, 70% of patients presented with chronic kidney disease, 69% with portal hypertension, 66% with hepatic failure, and 17% with Hepatitis C. Another 16% of patients were diagnosed with umbilical hernias. Only 10% of patients received a liver transplant, long-term abdominal drain, or transjugular intrahepatic portosystemic shunt during the three-year interval.

Results: Overall, our analysis found total mean Medicare costs exceed Medicare payments by 21 percent, suggesting underpayment deficits among most hospitals. Mean total hospital inpatient costs range from $50,694 (2017, CI $49,434, $51,955), to $23,923 (2019, $22,334, $25,513). Mean total hospital outpatient costs range from $15,946 (2017, $15,614, $16,278) to $11,454 (2019, $10,692, $12,216). This compares to mean Medicare inpatient payments of only $41,848 (2017, $40,891, $42,804) to $19,819 (2019, $18,656, $20,981). Mean Medicare outpatient payments ranged from $12,547 (2017, $12,276, $12,818) to $10,325 (2019, $9,734, $10,915).

Discussion: Cirrhosis-related ascites requiring ≥3 paracentesis procedures is associated with high mortality, morbidity and major costs to US hospitals that are not fully covered by Medicare. This burden is insufficiently addressed by liver transplantation and therefore continues to be an unmet and expensive need in patients with cirrhosis and ascites.


Figure: Patient Counts by Year, Cohort of High-Volume Liver-Related Ascites Patients, Medicare Standard Analytic Files, 2017-2019


Figure: Hospital Costs Per Patient Per Year and Medicare Payments for Liver Ascites Patients with High Frequency Paracentesis, Cohort of High-Volume Liver Related Ascites Patients, Medicare Standard Analytic Files, 2017-2019

Disclosures:
Jasmohan Bajaj: Bausch – Grant/Research Support. Genfit – Grant/Research Support. Salix Pharmaceuticals – Clinical trial investigator. Sequana – Grant/Research Support.
Sammy Saab: abbvie – Speakers Bureau. eton – Advisor or Review Panel Member. gilead – Advisor or Review Panel Member, Advisory Committee/Board Member, Consultant, Speakers Bureau. ipsen – Advisor or Review Panel Member, Advisory Committee/Board Member, Speakers Bureau. kezar – Advisory Committee/Board Member. madrigal – Advisor or Review Panel Member, Advisory Committee/Board Member, Speakers Bureau. orphalan – Advisory Committee/Board Member. salix – Advisory Committee/Board Member, Speakers Bureau.
Gijs Klarenbeek: Indigo Diabetes – Consultant, Independent Contractor. Medtronic – Consultant, Independent Contractor. Sequana Medical – Consultant, Independent Contractor, Intellectual Property/Patents, Stock Options, Stock-publicly held company(excluding mutual/index funds). Synergia Medical – Consultant, Independent Contractor. XEOS Medical – Consultant, Independent Contractor.
Stephen Hull: Sequana Medical BV – Consultant.

Jasmohan S.. Bajaj, MD, MS, FACG¹, Sammy Saab, MD, MPH², Gijs Klarenbeek, MD³, Stephen Hull, MHS⁴. P3799 - Medicare Patients With Cirrhosis and Ascites Requiring Repeated Paracentesis Present Major Uncovered Hospital Costs, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.