More than one-third of cirrhosis cases are related to alcohol, a seven-year national study of more than 100 million privately insured people has found. Among that group, 294,215 people had cirrhosis; 105,871 (36%) had alcohol-related cirrhosis.
The latter group was sicker and admitted or readmitted to a hospital more often, incurring nearly twice the health care costs per person: $44,835 versus $23,329.
"When I look at this data, it tells me that this is a big problem," says Jessica Mellinger, M.D., a Michigan Medicine gastroenterologist and health services researcher at the Institute for Healthcare Policy & Innovation.
And it could be a particularly big problem for women, who in recent years have been diagnosed with alcohol use disorders at a rate nearly twice that of men.
Mellinger's study, published in the journal Hepatology, found that women showed a 50% increase in alcohol-related cirrhosis during that seven-year period; men showed a 30% increase. Although biology doesn't explain why women appear to be consuming more alcohol then they used to, it does shed light on the effects.
A costly, widespread issue
To conduct their study, Mellinger and her team examined privately insured individuals ages 18 to 64 by using the Truven MarketScan Commercial Claims and Encounters database. It is the largest dataset of claims for people with private insurance obtained through their employers.
The study's goal was to determine the prevalence, health-care utilization, and costs of alcohol-related cirrhosis among privately insured people in the United States. The research showed:
1. Patients with alcohol-related cirrhosis aren't uncommon. The figures nearly surpass those of some common cancers.
2. Health care for these patients is costly, sometimes as much as the cost for cancer patients.
3. Cirrhosis has already progressed when many patients see a doctor for symptoms, preventing a chance for early diagnosis and treatment.
"At the time we did this study, we also considered using data sets from Medicare and Medicaid, but they were restricting reporting of claims related to substance abuse, and we knew we'd be missing information," said Mellinger.
Alcohol-use treatment programs vital
Prior research has shown that there is no ethical justification for deprioritizing patients from receiving a transplant because they have the alcohol-related liver disease.
"But first they will need alcohol cessation treatment before they can be transplanted with success," said Mellinger. "Alcohol-use treatment is effective, and many patients do stop drinking, obtain transplant and do well afterward."
Although there is a stigma to alcohol-related cirrhosis, it is common, and it's not a moral failure, she adds. "Many people in the medical community think that alcohol use is not treatable, but it is. There is a lot of collaboration at U-M to provide the right help for patients with the alcohol-related liver disease."
"Once you have cirrhosis or scar tissue on the liver, it's permanent," says Mellinger, who works closely with the University of Michigan psychiatry department and the University of Michigan Addiction Treatment Services.