A cross-sectional study to estimate the cost of managing patients with acute on chronic liver failure at a tertiary care centre

Abstract

Background

Acute-on-chronic liver failure (ACLF) is a life threatening disease. This study seeks to identify factors that contribute to greater financial burden in ACLF.

Methods

In total, 55 patients were included. ACLF was defined as per ‘European Association for the Study of the Liver-Chronic liver failure (EASL-CLIF)’ criteria. Patient's sociodemographic profile, comorbidities, clinical features as well as ‘Child–Turcotte–Pugh (CTP)' score, ‘Model for end stage liver disease-Sodium (MELD-Na)’, ‘Acute physiology and chronic health evaluation (APACHE-II)’ and sequential organ failure assessment score (SOFA) scores were recorded. Direct costs (medicines, doctor visits, investigations, procedures, treatment), direct non-medical cost (transportation, food and accommodation), and indirect costs (due to loss of productivity by patient and care giver) were calculated. All charges were as prescribed by central government health scheme (CGHS). Patients were followed till discharge/death.

Results

The mean cost of management of ACLF was Indian Rupee (₹) 178,483 ± 83,460, equivalent to United States Dollars ($) 2174.69 ± 1016.90. The direct medical costs, direct non-medical costs and indirect costs were ₹134,310 ± 62,796 (1639.56 ± 766.5$), 13,809 ± 8455 (168.5 ± 103.2$) and ₹0.30,364 ± 21,142 (370.6 ± 258 $), respectively.

There was no significant correlation between total cost and demographic and clinical variables. Length of intensive care unit (ICU) stay incurred higher cost (p < 0.0001). We found direct positive correlation between total cost of management and ICU stay (R = 0.80) and duration of hospital stay (R = 0.77). A negative correlation was revealed between total cost of managing ACLF and APACHE-II score (R = −0.10), MELD-Na score (R = −0.13).

Conclusion

The current study can serve as a benchmark for future research on ACLF cost management.