THE COST OF DYING OF END-STAGE LIVER-DISEASE

Background: The high cost of liver transplantation is well known. The cost of dying of complications of endstage liver disease (ESLD) withou t transplant, however, has not been well documented. Methods: For a 5- year period (1991-1995), in 153 patients, mean inpatient hospital char ges and length of stay were analyzed in 6 groups of patients: (1) pati ents admitted with the primary diagnosis of esophageal varices, (la) t he subset of group 1 patients who died on this admission, (2) patients admitted to the liver team who died of complications from ESLD, (3) p atients who underwent transjugular intrahepatic portosystemic shunts, (4) patients who underwent surgical shunt for bleeding varices, and (5 ) patients who underwent liver transplantation. Results: One hundred t wenty-nine patients with esophageal varices were hospitalized 13.7 day s with a mean charge of $30 980 for each of 202 admissions. Of these, 38 died after 24 days with a mean charge of $67 091. Seven patients ad mitted to the liver team died of complications of ESLD at $110 576 per admission. Transjugular intrahepatic portosystemic shunt was performe d in 17 patients with a mean charge of $43 209. Six patients underwent surgical shunt for $53 994. Mean charge for 7 liver transplantations was $222 968. During the study period, 36.7% of all charges were for p atients who died. Conclusions: It is difficult to estimate the total c ost of ESLD; however, in evaluating inpatient costs, we see that it is expensive and significant amounts are spent on patients who die. Furt her study is necessary to determine which factors can optimize the cos t of ESLD.