ThehealthcaresituationforcirrhosisinGermany

High mortality with limited access to curative therapies

Patients with decompensated cirrhosis have a high disease burden and a very high one-year mortality rate.

Publication data

Journal: Liver International
Publication: 2023
Authors: Lange, Trebicka, Gerbes, Canbay, Geier, Merle, Peck-Radosavljevic, Tacke, Vogelmann, Theis, Heinze, Zipprich
Type of study: Longitudinal observational study
Data base: A representative, anonymised statutory health insurance claims database covering 4.9 million people with statutory health insurance

Authors and affiliations

Department of Medicine II, University Hospital, LMU, Munich, Germany Christian M. Lange & Alexander Gerbes Department of Internal Medicine B, University of Münster, Münster, Germany Jonel Trebicka Department of Internal Medicine, University Hospital of the Knappschaftskrankenhaus Bochum, Bochum, Germany Ali Canbay Division of Hepatology, Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany Andreas Geier Internal Medicine IV Gastroenterology, Heidelberg University Hospital, Heidelberg, Germany Uta Merle Internal Medicine and Gastroenterology, Clinic Klagenfurt am Wörthersee, Klagenfurt, Austria Markus Peck-Radosavljevic Department of Hepatology and Gastroenterology, Charité - Universitätsmedizin Berlin, Berlin, Germany Frank TackeLinkCare GmbH, Ludwigsburg, Germany Tobias Vogelmann & Sina Theis CSL Behring, Hattersheim, Germany Hartmut Heinze Department of Internal Medicine IV, University Hospital Jena, Jena, Germany Alexander Zipprich

This longitudinal observational study analyses the prevalence, comorbidities, mortality, resource consumption and costs of patients with liver cirrhosis in Germany. Special focus is placed on the care situation for decompensated cirrhosis and access to liver transplantation and TIPS.

Key results

Prevalence in 2015: 250 per 100,000 inhabitants, extrapolated to 201,747 patients
Decompensation: 16.0% of compensated patients developed decompensation within three years
Costs per quarter: €7,172 for decompensated cirrhosis vs. €2,213 for compensated cirrhosis
One-year mortality: 51% following decompensation vs. 8% for compensated cirrhosis
Access to treatments: Only 1% received a liver transplant; 5% received TIPS

Classification and conclusion

The study shows a high burden of disease in patients with cirrhosis, especially in the decompensated stage. Despite high resource utilisation, only a few patients have access to potentially life-saving therapies. Liver cirrhosis causes a considerable medical and economic burden in Germany. The results indicate relevant gaps in care for advanced disease.