Impact of Severity of Chronic Liver Disease on Health-Related Economics

Abstract

Background: Chronic liver disease (CLD) is one of the leading causes of morbidity and mortality worldwide. It is accountable for a multifaceted disease encumbrance upsetting the psychological, physical, and economic health of not only the patients but also their caregivers. Objectives: The study purposes to cover the economic aspect of CLD to comprehend the financial burden imposed on the patients. Methods: This cross-sectional study was conducted at a tertiary care hospital in Karachi, Pakistan. The CLD patients presenting in gastroenterology clinics were recruited, and their socio-demographic, financial, and disease-related information including Model for End-stage Liver Disease (MELD) score and Child Turcotte Pugh (CTP) scores were collected. Out of 190 CLD patients enrolled, 127 (67.2%) were males. The mean age was 50.09 years. Variables assessed include self-perceived social/economic status, self-perception of disease responsibility for worsening of social/economic situation, the impact of the disease on economic status due to medical expense, the impact of economic status on treatment compliance due to medical expenses, impact of severity of disease on socioeconomic status and treatment compliance, and impact of gender on disease status and treatment compliance. Results: Regardless of the disease duration, CLD significantly impacted a patient’s life, as 81% and 69% of the patients blamed their disease responsible for the worsening of social and economic conditions, respectively. In our study, 85% of patients had consumed all savings during their course of illness, and 67% had to borrow money for medical expenses. Nearly half of the patients had to leave or cut short their medicines, skip the physician's appointment, or defer their children's education. One-third of patients had unpaid medical and utility bills or even skipped their meals. The severity of disease affected the socioeconomic status significantly (89% in CTP class C vs. 40% in CTP class A). Patients with worsening socioeconomic status had significantly higher MELD scores as compared to those with stable socioeconomic status. Conclusions: Chronic liver disease imposes incredible socioeconomic encumbrance on patients and the family unit, and CLD associated expenditures influence the family unit’s everyday working and therapeutic compliance, which is directly linked to the severity of disease expressed in terms of CTP and MELD scores.