Hospital resource utilisation in patients with cirrhosis-related ascites requiring paracentesis in England

Objective: Ascites is the most common complication of liver cirrhosis and is associated with increased morbidity and mortality. We aimed to describe hospital-based healthcare resource utilisation (HCRU) and costs in patients with ascites requiring drainage in England. Methods: Patients with cirrhosis and ascites requiring paracentesis between April 2016 and March 2019 were retrospectively identified from Hospital Episode Statistics (HES). First paracentesis was defined as index event. Patients were followed up for 12 months, until death, liver transplant or transjugular intrahepatic portosystemic shunt insertion; classified as non-recurrent if no further paracentesis was reported, recurrent if ≥1 further paracentesis was reported or refractory if ≥3 paracenteses <28 days apart were reported. Demographics, clinical characteristics, encounters, liver-related complications and costs were gathered. HES analysis was validated by thorough case-note review at University Hospitals Plymouth applying similar methodology. Results: A total of 3558 non-recurrent, 873 recurrent and 529 refractory ascites patients were identified in HES. Mean age was 58.8 years, most (63.2%) were men. HCRU and complications increased with ascites severity. Patients with refractory ascites required over two times as many inpatient admissions/year than recurrent patients (13.8 vs 5.4) and over 30% more outpatient visits (16.0 vs 11.8). Average cost/patient/year also increased with severity (£10 440 vs £25 854 vs £40 244). Demographics, HCRU and complications in the audit cohort support the findings in the HES cohort. Conclusions: This study reinforces the unmet need for improved treatments for patients with cirrhosis-related ascites who face repeated admissions and increasing complications, and the high-cost burden of managing these cases places on the National Health Service.