Patient Costs, Characteristics, and Outcomes Associated with Hepatitis B and Hepatitis C Hospitalizations — California, 2002–2011

BACKGROUND:   Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are the most prevalent chronic bloodborne infections in the United States.  Chronic HBV or HCV infections may lead to hepatic coma, liver cancer, or death.  Our objective was to characterize patient costs, demographics, and outcomes associated with HBV and HCV hospitalizations in California.

METHODS:   We reviewed hospitalizations in non-federal California acute care facilities with discharge dates during 2002–2011 and an International Classification of Disease revision 9 diagnosis code for HBV or HCV infection.  We restricted analysis to those hospitalizations with any of the following: (1) a primary diagnosis code for HBV or HCV infection; or (2) any diagnosis code for hepatic cancer, liver disease sequelae, liver transplant complications, or hepatic coma; or (3) a procedure code for liver transplant.  Hospitalizations for the same person were matched and aggregated.  Patients with a history of both HBV and HCV infections were considered coinfected.  We characterized charges, demographics, and outcomes associated with HBV infection, HCV infection, and coinfection. 

RESULTS:   Of 105,279 patients hospitalized with HBV- or HCV-related conditions, 11,341 (11%) were HBV-infected, 84,730 (80%) were HCV-infected, and 9,208 (9%) were coinfected.  Of $18.4 billion in charges, $1.5 billion (8%) were accrued by HBV-infected patients, $14.3 billion (77%) were accrued by HCV-infected patients, and $2.6 billion (14%) were accrued by coinfected patients.  HBV-infected, HCV-infected, and coinfected patients were most commonly male (69%, 68%, and 71%, respectively) and 45–59 years of age at first hospitalization (38%, 57%, and 58%, respectively).  HBV-infected patients were most commonly Asian or Pacific Islander (46%).  HCV-infected and coinfected patients were most commonly White (49% and 46%, respectively).  Cancer was most common among HBV-infected patients (30%).  Hepatic coma was most common among HCV-infected and coinfected patients (35% and 49%, respectively).  A large proportion of HBV-infected, HCV-infected, and coinfected patients died (20%, 21%, and 28%, respectively).

CONCLUSIONS:   HBV- and HCV-related conditions were a large burden on the California healthcare system resulting in more than 100,000 patients hospitalized and more than $18 billion in charges over 10 years.  Demographic characteristics among patients hospitalized with HBV or HCV are consistent with those identified in national survey data.  Serious outcomes such as cancer, hepatic coma, and death were not uncommon.  Currently available treatments can cure HCV infection and mitigate HBV infection sequelae.  Earlier identification and treatment of infection, medical monitoring, and behavioral changes can improve outcomes and may decrease medical costs for HBV-infected, HCV-infected, or coinfected patients.