The Scottish Alcoholic Liver disease Evaluation: a population-level matched cohort study of hospital-based costs, 1991-2011

Janet Bouttell, James Lewsey, Claudia Geue, Grace Anthony, Andrew Briggs, Gerry McCartney, Sharon Hutchinson, Lesley Graham, Mathis Heydtmann

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Abstract

Studies assessing the costs of alcoholic liver disease are lacking. We aimed to calculate the costs of hospitalisations before and after diagnosis compared to population controls matched by age, sex and socio-economic deprivation. We aimed to use population level data to identify a cohort of individuals hospitalised for the first time with alcoholic liver disease in Scotland between 1991 and 2011.Incident cases were classified by disease severity, sex, age group, socio-economic deprivation and year of index admission. 5 matched controls for every incident case were identified from the Scottish population level primary care database. Hospital costs were calculated for both cases and controls using length of stay from morbidity records and hospital-specific daily rates by specialty. Remaining lifetime costs were estimated using parametric survival models and predicted annual costs. 35,208 incident alcoholic liver disease hospitalisations were identified. Mean annual hospital costs for cases were 2.3 times that of controls pre diagnosis (£804 higher) and 10.2 times (£12,774 higher) post diagnosis. Mean incident admission cost was £6,663. Remaining lifetime cost for a male, 50–59 years old, living in the most deprived area diagnosed with acoholic liver disease was estimated to be £65,999 higher than the matched controls (£12,474 for 7.43 years remaining life compared to £1,224 for 21.8 years). In Scotland, alcoholic liver disease diagnosis is associated with significant increases in admissions to hospital both before and after diagnosis. Our results provide robust population level estimates of costs of alcoholic liver disease for the purposes of health-care delivery, planning and future cost-effectiveness analyses.
Original languageEnglish
Pages (from-to)1-15
Number of pages15
JournalPLoS ONE
Volume11
Issue number10
Early online date26 Oct 2016
DOIs
Publication statusPublished - Oct 2016

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Alcoholic Liver Diseases
Hospital Costs
liver diseases
alcohol abuse
cohort studies
Liver
Cohort Studies
Costs and Cost Analysis
Population
Costs
Scotland
socioeconomics
Hospitalization
Economics
gender
cost effectiveness
disease diagnosis
Population Control
Hospital Records
disease severity

Keywords

  • SCottish Alcoholic Liver disease Evaluation (SCALE)
  • hepatology
  • hospital admissions

Cite this

Bouttell, J., Lewsey, J., Geue, C., Anthony, G., Briggs, A., McCartney, G., ... Heydtmann, M. (2016). The Scottish Alcoholic Liver disease Evaluation: a population-level matched cohort study of hospital-based costs, 1991-2011. PLoS ONE , 11 (10), 1-15. https://doi.org/10.1371/journal.pone.0162980
Bouttell, Janet ; Lewsey, James ; Geue, Claudia ; Anthony, Grace ; Briggs, Andrew ; McCartney, Gerry ; Hutchinson, Sharon ; Graham, Lesley ; Heydtmann, Mathis. / The Scottish Alcoholic Liver disease Evaluation: a population-level matched cohort study of hospital-based costs, 1991-2011. In: PLoS ONE . 2016 ; Vol. 11 , No. 10. pp. 1-15.
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title = "The Scottish Alcoholic Liver disease Evaluation: a population-level matched cohort study of hospital-based costs, 1991-2011",
abstract = "Studies assessing the costs of alcoholic liver disease are lacking. We aimed to calculate the costs of hospitalisations before and after diagnosis compared to population controls matched by age, sex and socio-economic deprivation. We aimed to use population level data to identify a cohort of individuals hospitalised for the first time with alcoholic liver disease in Scotland between 1991 and 2011.Incident cases were classified by disease severity, sex, age group, socio-economic deprivation and year of index admission. 5 matched controls for every incident case were identified from the Scottish population level primary care database. Hospital costs were calculated for both cases and controls using length of stay from morbidity records and hospital-specific daily rates by specialty. Remaining lifetime costs were estimated using parametric survival models and predicted annual costs. 35,208 incident alcoholic liver disease hospitalisations were identified. Mean annual hospital costs for cases were 2.3 times that of controls pre diagnosis (£804 higher) and 10.2 times (£12,774 higher) post diagnosis. Mean incident admission cost was £6,663. Remaining lifetime cost for a male, 50–59 years old, living in the most deprived area diagnosed with acoholic liver disease was estimated to be £65,999 higher than the matched controls (£12,474 for 7.43 years remaining life compared to £1,224 for 21.8 years). In Scotland, alcoholic liver disease diagnosis is associated with significant increases in admissions to hospital both before and after diagnosis. Our results provide robust population level estimates of costs of alcoholic liver disease for the purposes of health-care delivery, planning and future cost-effectiveness analyses.",
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Bouttell, J, Lewsey, J, Geue, C, Anthony, G, Briggs, A, McCartney, G, Hutchinson, S, Graham, L & Heydtmann, M 2016, 'The Scottish Alcoholic Liver disease Evaluation: a population-level matched cohort study of hospital-based costs, 1991-2011', PLoS ONE , vol. 11 , no. 10, pp. 1-15. https://doi.org/10.1371/journal.pone.0162980

The Scottish Alcoholic Liver disease Evaluation: a population-level matched cohort study of hospital-based costs, 1991-2011. / Bouttell, Janet; Lewsey, James; Geue, Claudia; Anthony, Grace; Briggs, Andrew ; McCartney, Gerry ; Hutchinson, Sharon; Graham, Lesley; Heydtmann, Mathis.

In: PLoS ONE , Vol. 11 , No. 10, 10.2016, p. 1-15.

Research output: Contribution to journalArticle

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AU - Briggs, Andrew

AU - McCartney, Gerry

AU - Hutchinson, Sharon

AU - Graham, Lesley

AU - Heydtmann, Mathis

N1 - Accepted: 31-8-16 Online pub: 26-10-16 Gold OA Note on publication re data availability: Data Availability: Due to ethical concerns, access to the third-party data on hospitalisations in Scotland is subject to the scrutiny of the Public Benefit and Privacy Panel for Health and Social Care. Applications can be made to ISD Scotland through the eDRIS system available at: http://www.isdscotland.org/Products-and-Services/EDRIS/.

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N2 - Studies assessing the costs of alcoholic liver disease are lacking. We aimed to calculate the costs of hospitalisations before and after diagnosis compared to population controls matched by age, sex and socio-economic deprivation. We aimed to use population level data to identify a cohort of individuals hospitalised for the first time with alcoholic liver disease in Scotland between 1991 and 2011.Incident cases were classified by disease severity, sex, age group, socio-economic deprivation and year of index admission. 5 matched controls for every incident case were identified from the Scottish population level primary care database. Hospital costs were calculated for both cases and controls using length of stay from morbidity records and hospital-specific daily rates by specialty. Remaining lifetime costs were estimated using parametric survival models and predicted annual costs. 35,208 incident alcoholic liver disease hospitalisations were identified. Mean annual hospital costs for cases were 2.3 times that of controls pre diagnosis (£804 higher) and 10.2 times (£12,774 higher) post diagnosis. Mean incident admission cost was £6,663. Remaining lifetime cost for a male, 50–59 years old, living in the most deprived area diagnosed with acoholic liver disease was estimated to be £65,999 higher than the matched controls (£12,474 for 7.43 years remaining life compared to £1,224 for 21.8 years). In Scotland, alcoholic liver disease diagnosis is associated with significant increases in admissions to hospital both before and after diagnosis. Our results provide robust population level estimates of costs of alcoholic liver disease for the purposes of health-care delivery, planning and future cost-effectiveness analyses.

AB - Studies assessing the costs of alcoholic liver disease are lacking. We aimed to calculate the costs of hospitalisations before and after diagnosis compared to population controls matched by age, sex and socio-economic deprivation. We aimed to use population level data to identify a cohort of individuals hospitalised for the first time with alcoholic liver disease in Scotland between 1991 and 2011.Incident cases were classified by disease severity, sex, age group, socio-economic deprivation and year of index admission. 5 matched controls for every incident case were identified from the Scottish population level primary care database. Hospital costs were calculated for both cases and controls using length of stay from morbidity records and hospital-specific daily rates by specialty. Remaining lifetime costs were estimated using parametric survival models and predicted annual costs. 35,208 incident alcoholic liver disease hospitalisations were identified. Mean annual hospital costs for cases were 2.3 times that of controls pre diagnosis (£804 higher) and 10.2 times (£12,774 higher) post diagnosis. Mean incident admission cost was £6,663. Remaining lifetime cost for a male, 50–59 years old, living in the most deprived area diagnosed with acoholic liver disease was estimated to be £65,999 higher than the matched controls (£12,474 for 7.43 years remaining life compared to £1,224 for 21.8 years). In Scotland, alcoholic liver disease diagnosis is associated with significant increases in admissions to hospital both before and after diagnosis. Our results provide robust population level estimates of costs of alcoholic liver disease for the purposes of health-care delivery, planning and future cost-effectiveness analyses.

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