Healthcare utilisation, expenditure, and admission-based mortality associated with paediatric hepatobiliary diseases in Thailand: a national database analysis (2015–2023)

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Background Population-level epidemiological data on paediatric hepatobiliary diseases (HBD) are limited in Southeast Asia. We aimed to quantify national trends in healthcare utilisation, expenditure, and admission-based mortality associated with paediatric HBD in Thailand. Methods We conducted a retrospective cohort study of hospital admissions among individuals younger than 18 years of age using Thailand's National Health Security Office (NHSO) database from 2015 to 2023. HBD were identified using ICD-10-TM codes. To demonstrate the burden of HBD, we analysed admission rates (AR), length of stay (LOS), NHSO payments, and inpatient mortality rate (IMR). Sensitivity analyses excluding the COVID-19 pandemic years were performed. Findings Among 60,916 admissions, 31,158 (51·1%) were male, and the median (IQR) age was 10 (3–14) years. The median (IQR) admission rate (AR) was 59·0 (56·1–65·9) per 100,000 population, with an AAPC of −0·61 (95% CI −2·90 to 1·68). Declining trends in AR were observed for several conditions, including acute hepatitis A, acute hepatitis B, hepatic failure, and cirrhosis. Infants had longer LOS, higher healthcare payments, and higher annual mortality (AM) rate than older children (all p < 0·0001). Median (IQR) annual healthcare expenditure was 11·333 (11·151–11·550) million USD. Overall AM rate was 52·4 (45·5–53·9) deaths per 1000 admissions and declined over time (AAPC −4·94; 95% CI −7·35 to −2·52), with similar findings in sensitivity analyses. However, mortality related to hepatic failure remained high without significant temporal improvement. Interpretation Paediatric HBD continue to impose a substantial burden on Thailand's healthcare system. Although overall inpatient mortality declined significantly over time, persistently high mortality in hepatic failure highlights ongoing gaps in specialised care. Strengthening referral pathways, critical care capacity, and access to liver care services may further improve outcomes for affected children. Funding No funding.

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