New Data Show Rise in Decompensated Cirrhosis and Hepatic Encephalopathy Cases among US Medicare Beneficiaries

The prevalence of decompensated cirrhosis and overt hepatic encephalopathy (OHE) increased among Medicare beneficiaries over the past 15 years, according to new research presented at the American Association for the Study of Liver Diseases’ annual scientific conference, The Liver Meeting 2023, held November 10-14, in Boston, MA.

Findings also showed that during the same 15-year timeframe (2006-2020), there were declines in OHE hospitalizations, “which may reflect improvements in management of OHE,” wrote presenting author Robert J. Wong, MD, clinical associate professor (affiliated), Department of Medicine, Gastroenterology, and Hepatology, Stanford University School of Medicine, and colleagues.

In patients with cirrhosis, the development of hepatic decompensation, including OHE, is associated with an increased risk of morbidity, according to researchers.

“Understanding the burden of cirrhosis and its complications over time is important to accurately assess healthcare utilization,” wrote Wong and coauthors. “This study describes the trends in decompensated cirrhosis among Medicare beneficiaries in the [US], with a focus on the prevalence of OHE and related hospitalizations and medication use.”

Investigators identified Medicare beneficiaries aged ≥65 years with cirrhosis—defined as ≥2 diagnoses of cirrhosis or its complications—using the 100% Medicare Research Identifiable Files (2006-2020), according to the abstract.

For each year, the prevalence of decompensated cirrhosis—defined as ascites, variceal bleeding, hepatorenal syndrome, OHE, or spontaneous bacterial peritonitis—was estimated among patients with cirrhosis who had Medicare enrollment for the entire calendar year.

“Prevalence of decompensated cirrhosis and OHE among patients with cirrhosis were reported overall and by age and sex,” added researchers. They estimated the annual prevalence of OHE medication use (ie, lactulose and/or rifaximin) among patients with cirrhosis and OHE hospitalizations among patients with OHE from 2006 to 2020.

FINDINGS

Among patients with cirrhosis, the prevalence of decompensated cirrhosis increased by 0.9% year-over-year (YOY), rising from 36.7% in 2006 to 42.7% in 2020 (P<.001), and the prevalence of OHE grew by 2.7% YOY from 14.9% to 20.9%, respectively (P<.001).

When researchers used multiple sensitivity analyses, they found that the prevalence of OHE among patients with cirrhosis ranged from 20.9% in 2006 to 31.7% in 2020. Also, the prevalence of OHE appeared higher among men (2006: 15.5%; 2020: 22.2%) than women (2006: 14.5%; 2020: 19.7%) and higher among patients aged 65-74 years (2006: 15.8%; 2020: 22.9%) than those aged ≥75 years (2006: 13.6%; 2020: 18.2%).

“Rifaximin utilization among patients with cirrhosis was 1.2% at its approval in 2010, 4.1% in 2014, and 3.1% in 2020,” noted Wong and colleagues.

In addition, researchers observed that among patients with OHE, the prevalence of OHE hospitalizations decreased during the 15-year period, dropping from 36.9% in 2006 to 9.5% in 2020.

“Future studies are warranted to explore the factors contributing to the observed trends,” concluded investigators.

Source: Wong RJ, Gagnon-Sanschagrin P, Heimanson Z, et al. Fifteen-year trends in the prevalence of decompensated cirrhosis and overt hepatic encephalopathy among Medicare beneficiaries in the United States (2006-2020). Abstract presented at The Liver Meeting 2023; November 10-14, 2023; Boston, MA.