A University of Houston College of Pharmacy professor has published two studies offering a comprehensive look at chronic liver disease in the era of modern antiviral therapies. One study is the first analysis of its economic and human toll; the other examines patient adherence to second-generation antiviral medications, a key factor in preventing disease prevention and treatment in hepatitis C. Chronic liver disease may arise from persistent viral infections like hepatitis B or C, alcohol-related liver disease, metabolism-related fatty liver disease and autoimmune liver disease.
The findings in both studies underscore the need for stronger prevention and management efforts, contributing to ongoing work at the University of Houston to better understand and address chronic conditions.
The cost and human toll
Rajender Aparasu, UH Mustafa and Sanober Lokhandwala Endowed Professor of Pharmacy, led a research team that found the staggering cost of chronic liver disease for patients in the United States reaches $41.57 billion.
“Advanced stages of chronic liver disease, marked by extensive fibrosis and cirrhosis, provide a considerable public health challenge, significantly impacting morbidity, mortality and healthcare expenditures,” reports Aparasu in Expert Review of Pharmacoeconomics & Outcomes Research . Aparasu, who also serves as chair of the Department of Pharmaceutical Health Outcomes and Policy at UH, found that prescription medication expenditures accounted for nearly half (47.36%) of all-cause healthcare expenditures among liver disease patients.
The national study examined health care expenditures, productivity loss, and health-related quality of life. The UH team conducted a retrospective, cross-sectional analysis using the 2014–2021 Medical Expenditure Panel Survey involving patients with chronic liver disease over the age of 18. Multivariable models were used to evaluate incremental direct medical costs, missed workdays, and the difference in quality of life.
“While therapeutic agents for hepatitis B and C have transformed treatment for chronic liver disease in the last two decades, their substantial prescription costs contribute to the overall economic burden for patients and the healthcare system,” noted UH Ph.D. candidate and Fulbright Scholar Javeria Khalid, lead author of the paper, who previously served as a clinical pharmacist in a hospital liver transplant unit. “Conversely, untreated chronic liver disease patients can impose a considerable financial burden on the health care system due to complications associated with CLD, including the need for liver transplantation.”
By the numbers
Annually, 1.63 million patients are diagnosed with chronic liver disease
The annual healthcare expenditure attributable to CLD is $11,711 per patient
Patients with CLD have 0.12 more missed workdays, translating into a national productivity loss of $51.6 million
Quality of life in CLD patients is lower by 3.72 points for physical health and 1.83 points for mental health
The UH team also found that the burden in numerous industrialized nations has progressively transitioned toward fatty liver disease primarily due to increased obesity and metabolic syndrome.
“The study findings emphasize the need for targeted interventions to alleviate the multifaceted impact of chronic liver disease and to support strategies to reduce the overall burden of the disease,” said Aparasu, who has been involved in liver research for the past decade, addressing various aspects of pharmacotherapy, including adherence, comparative effectiveness and safety.
The need for adherence
Aparasu also published a study in the journal Pharmacotherapy on adherence to second-generation direct-acting antiviral agents, which is crucial for preventing disease progression and reducing treatment resistance in patients with hepatitis C. Rather than boosting the immune system, direct-acting medications go straight for the virus.
Aparasu found that high monthly out‐of‐pocket costs (≥ $400) increased the risk of non‐adherence, and that patients with cirrhosis, HIV infection, and substance use disorder were found to have higher odds of being non‐adherent.
“Findings from this study can inform the development of targeted interventions to optimize DAA adherence in hepatitis C,” he said.
Expert Review of Pharmacoeconomics & Outcomes Research
Economic and humanistic burden of chronic liver diseases in the United States
9-Mar-2026