# Natural history, risk prediction and cost of cirrhosis in insured Americans.

> **NIH NIH R01** · NORTHWESTERN UNIVERSITY · 2023 · $673,776

## Abstract

SUMMARY
Cirrhosis is a leading cause of mortality in the United States (US), diagnosed in 1.5-9.4 million Americans and
results in over 40,000 deaths each year. Every year 5-7% patients with cirrhosis experience life-threatening
decompensating events, such as ascites, hepatic encephalopathy (HE), gastrointestinal bleeding (GIB), or
develop hepatocellular carcinoma (HCC). These events often result in hospitalization, disability, or even death.
The challenge is to accurately predict those patients who are likely to develop decompensating events
and are likely to die. Accurate risk stratification of persons with cirrhosis will allow for early identification
and prioritization for guideline recommended care and emerging therapies (e.g., statins). Several
predictive models exist but none of them adequately answers this question. Furthermore, no longitudinal cost
of care analyses and cost prediction has been performed in the US for persons with cirrhosis. The care
of patients with cirrhosis is complex, often involving costly recurrent hospitalizations and procedures. In 2015,
the hospital costs alone were reported to be $16.3 billion. Our proposed research will analyze a large national
administrative health payer with detailed information on diagnoses, procedures, laboratory tests, medications,
in- and outpatient care, as well as standardized costs for insured Americans between 2011 and 2018. Such a
large population-based cirrhosis cohort, which includes cost data, offers a unique and unprecedented opportunity
to study disease progression, develop highly accurate prediction models, and study costs.
Aim 1. To describe the natural history of cirrhosis over time in a large longitudinal cohort of insured
Americans with liver cirrhosis in the United States
 Aim 1.1: Data preparation and variable transformation
Aim 1.2: Adjudicate potentially risk-relevant covariates by a cirrhosis stakeholder panel
Aim 1.3: Describe the natural history of cirrhosis
Aim 2. To predict the risk of decompensation, hospitalization and death in patients with cirrhosis using
a large longitudinal administrative dataset (UNITED Health Group)
 Aim 2.1: Model the risk of decompensation
Aim 2.2: Model the risk of hospitalization
Aim 2.3: Merge the UHG dataset with the National Death Index and model the risk of death
Aim 3: To predict costs associated with all aspects of care in patients with liver cirrhosis
 Aim 3.1: Ascertain standardized cost stratified by state/phenotypes of liver cirrhosis
Aim 3.2: Model the cost of care over time

## Key facts

- **NIH application ID:** 10557845
- **Project number:** 5R01DK131164-02
- **Recipient organization:** NORTHWESTERN UNIVERSITY
- **Principal Investigator:** Daniela P Ladner
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $673,776
- **Award type:** 5
- **Project period:** 2022-02-01 → 2026-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10557845

## Citation

> US National Institutes of Health, RePORTER application 10557845, Natural history, risk prediction and cost of cirrhosis in insured Americans. (5R01DK131164-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10557845. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*