Association Between Pruritus and Healthcare Utilization and Costs Among Individuals with Primary Biliary Cholangitis in the United States


Summary for Medical Professionals

Title: Association Between Pruritus and Healthcare Utilization and Costs Among Individuals with Primary Biliary Cholangitis in the United States
 Authors: Robert G. Gish¹, Michel H. Mendler², Edward A. Mena², Chong Kim³, C. Fiorella Murillo Perez³, Yi Pan⁴, Lauren A. Do⁴, Mihail Samnaliev⁴, Diane Ito⁴, and Maria Agapova³
Institutions: ¹Robert G. Gish Consultants LLC, San Diego, CA; ²California Liver Research Institute, Pasadena, CA; ³Gilead Sciences, Foster City, CA; ⁴Stratevi, Santa Monica, CA

EPIC Study Pruritus AASLD Poste…


Presented at: American Association for the Study of Liver Diseases (AASLD) — The Liver Meeting®, Washington D.C., November 2025.

Background

Primary biliary cholangitis (PBC) is a chronic autoimmune liver disease that causes bile duct injury and progressive cholestasis, often leading to cirrhosis, liver failure, and hepatocellular carcinoma.
Pruritus (itching) is one of the most debilitating symptoms of PBC—affecting 50–75% of patients—yet it remains under-recognized and under-treated. Patients with PBC and pruritus often experience more comorbidities, lower quality of life, and greater healthcare burden than those without pruritus

EPIC Study Pruritus AASLD Poste…

This study provides large-scale, real-world evidence on how pruritus impacts healthcare resource utilization (HCRU) and annual costs among individuals with PBC in the United States.

Methods

A retrospective, longitudinal cohort study analyzed data from the Komodo Healthcare Map, which integrates national administrative claims and Quest Diagnostics laboratory data.

  • Study Period: September 2017 – September 2023.

  • Population: 52,034 adults diagnosed with PBC; 10,077 had pruritus (“cases”), and 41,957 did not (“controls”).

  • Inclusion Criteria: ≥1 inpatient or ≥2 outpatient PBC diagnoses ≥30 days apart, ≥12 months of continuous health coverage pre- and post-index, and age ≥18 years.

  • Analyses: Healthcare utilization (inpatient, outpatient, emergency room, and prescription fills) and total annual costs were compared between groups. Multivariable regression adjusted for demographics, comorbidities, insurance type, and PBC-related treatments.

Results

Patient Characteristics

  • Median age: 63 years (pruritus) vs 67 years (controls); 86% female.

  • Charlson Comorbidity Index (CCI): 3.5 (pruritus) vs 2.8 (controls), p<0.001.

  • Higher comorbidity rates in the pruritus group, including cirrhosis (40.3% vs 29.7%), autoimmune thyroid disease, Sjögren’s syndrome, and metabolic dysfunction-associated conditions.

  • UDCA use: higher among pruritus patients (62.4% vs 54.0%)
    EPIC Study Pruritus AASLD Poste…

Healthcare Utilization

After multivariable adjustment, pruritus was significantly associated with higher healthcare use across all settings:

Setting

Rate Ratio (RR)

95% CI

p-value

Inpatient

1.69

[1.55–1.84]

<.001

Emergency

1.65

[1.56–1.75]

<.001

Prescriptions

1.44

[1.40–1.49]

<.001

Outpatient

1.36

[1.33–1.39]

<.001

Utilization differences were greatest for inpatient (17% vs 9%) and emergency visits (33% vs 20%).

Healthcare Costs

  • Total annual healthcare costs: $39,949 for pruritus vs $25,695 for controls.

  • Incremental cost: +$14,254 per patient (p<.001).

  • Costs were more than double among those with pruritus, driven largely by non–PBC-related healthcare services.

  • Sensitivity analyses confirmed robustness:

    • Strict definition: +$27,669 incremental cost (p<.001).

    • Broad definition: +$11,495 incremental cost (p<.001)
      EPIC Study Pruritus AASLD Poste…

Conclusions

  • Pruritus significantly increases healthcare utilization and costs across all settings of care among patients with PBC.

  • Annual medical expenditures were more than twice as high for patients with pruritus.

  • Findings highlight the clinical and economic burden of this under-treated symptom and underscore the need for effective, targeted therapies to reduce both patient suffering and healthcare system strain.

 Summary for General Visitors

Itching in Liver Disease: A Costly and Overlooked Burden

Researchers from the California Liver Research Institute and collaborators across the U.S. studied over 50,000 patients with primary biliary cholangitis (PBC) to understand how itching (pruritus) affects health and costs.

What They Found

  • About 1 in 5 patients with PBC were diagnosed with pruritus.

  • These individuals had more hospital stays, more emergency visits, and higher prescription use than those without itching.

  • Their medical costs were twice as high, averaging nearly $40,000 a year compared to $25,000 for others.

  • People with itching also had more health complications, including cirrhosis, autoimmune conditions, and sleep or mood disorders.

Why It Matters

Pruritus is not just uncomfortable—it represents a major health and financial burden for patients and the healthcare system.
The study shows that better treatments and management strategies are urgently needed to improve quality of life and reduce avoidable costs for those living with PBC.

Presented at: American Association for the Study of Liver Diseases (AASLD) — The Liver Meeting®, Washington D.C., November 2025.