Medical Costs Increase Over Time for Primary Biliary Cholangitis Patients: A 20-Year Population-Based Study

Abstract

Background/Aims

The economic burden of primary biliary cholangitis (PBC) among Asians has not been investigated at the population level.

Methods

PBC patients were identified via the Taiwan National Health Insurance administrative database. Health services, including inpatient and outpatient activities, were used to estimate medical costs between 2002 and 2021. Inflation was adjusted according to the consumer price index.

Results

A total of 4772 PBC patients were enrolled. The overall total (inpatient and outpatient) [average annual percent change (AAPC): 14.69%, p < 0.0001], overall inpatient (AAPC: 14.12%, p < 0.0001), overall outpatient (AAPC: 16.64%, p < 0.0001), and mean outpatient medical costs (AAPC: 2.94%, p < 0.0001) increased over time. Compared with males, females had lower mean (p < 0.0001) total costs. The mean inpatient cost was higher among southern than among northern Taiwan PBC patients (p = 0.0024). Extrahepatic costs were lower than hepatic costs (p < 0.0001), with nonhepatocellular carcinoma (non-HCC) and diabetes being the main causes. The annual cost of cirrhosis, HCC and liver transplantation was 20,417 new Taiwan dollars (NTD). Age ≥ 80 years (estimated ß: 0.245, p = 0.028), female sex (−0.203, p < 0.0001), and dyslipidemia (−0.138, p < 0.0001) were associated independently with individual total costs.

Conclusion

The overall (total, inpatient and outpatient) and mean outpatient costs for PBC patients increased over time. Special attention and tailored treatments should be given to PBC subgroups, including males, elderly people, southern Taiwan residents, those with hepatic events, and those with diabetes, as this approach might effectively reduce medical costs. A new drug that is effective and costs ≤ NTD 20,417/year would benefit PBC patients in Taiwan.