Costs, Demographics, and Causative Agents in Patients Hospitalized for Drug Induced Liver Injury: Trends in a Large Academic Healthcare System

Megan Kozar,1 Yunisse Gonzalez,2 Dina Halegoua-DeMarzio3 1Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA; 2Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA; 3Department of Medicine, Division of Gastroenterology and Hepatology. Thomas Jefferson University Hospital at Sidney Kimmel Medical College, Philadelphia, PA, USACorrespondence: Megan Kozar, Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, 132 S 10th Street Main Building, Suite 480, Philadelphia, PA, 19107, USA, Email [email protected]: Drug-induced liver injury (DILI) is an uncommon but potentially life-threatening condition. To date, the burden of DILI on a single, large healthcare system has not been investigated, preventing adequate resource allocation. This study aims to quantify DILI-related healthcare utilization within the Jefferson Health System (JHS) and identify case-related factors associated with high resource requirements; such information is crucial to focus efforts toward resource reduction.Patients and Methods: This study characterizes trends of 48 DILI cases within JHS, including demographics, payer status, causative agent, and DILI pattern. These variables were correlated with length of stay (LOS) and cost relating to the treatment encounter. Patient-level observed LOS and cost were then subtracted from their respective expected values from the Vizient Clinical Database, a platform that provides clinical outcome data from more than 1300 healthcare facilities in the United States.Results: Treatment of DILI cases at JHS required higher than expected cost compared to the Vizient Clinical Database. We found high resource utilization in females, those identifying as black, and in cases where the implicated agent was uncertain. Mixed pattern DILI required the highest healthcare utilization, whereas herbal and dietary supplements (HDS) cases were relatively resource minimal.Conclusion: This study indicates that high clinical suspicion of DILI in historically marginalized populations and improved causative agent identification are key to minimizing the healthcare burden of DILI.Keywords: hepatotoxicity, clinical patterns, healthcare utilization, risk factors, patient characteristics