S2713 Medicare Patients With Cirrhosis and Ascites Requiring Repeated Paracentesis Present Major Uncovered Hospital Costs

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 U.S. original Medicare patients requiring regular paracentesis over a 3-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 3 paracentesis procedures during the year. Hepatocellular cancer patients were excluded. Overall, the patient cohort experienced mortality of 70.1% over the 3-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 3-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). Conclusion: 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.