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Fatigue and pruritus in patients with primary biliary cholangitis are associated with increased comorbidities, healthcare resource use, and costs.

This US matched case-control study found that PBC patients with fatigue or pruritus had significantly more comorbidities (e.g., anxiety, depression, sleep disorders) at 1, 3, and 5 years post-index compared to those without these symptoms. They also had 1.6 to 6.1 times more healthcare visits and total healthcare costs were over $40,000 higher per patient per year.

Last updated: Aug 14, 2026•0 RCTs•📖 Read as article →

Evidence Score

Evidence Score34/100
Human RCT☆☆☆☆☆
Meta-analysis☆☆☆☆☆
Mechanism★★★★★
Safety★★★★☆
Confidencelow

Study Evidence

Study 1. Burden of fatigue or pruritus in patients with primary biliary cholangitis: a United States matched case-control study.

observational

Kumar S, Shamseddine N, Yang H, Zhang S, Chen J, Kowdley KV · Journal of comparative effectiveness research (2026)

Participants: N/A
Duration: Up to 5 years follow-up (comorbidities at 1, 3, 5 years)
Intervention: Observational comparison of PBC patients with fatigue/pruritus versus those without (no intervention)
Outcome: Cumulative incidence of comorbidities, healthcare resource use (visits), and total healthcare costs
Effect Size: Hazard ratios: 1.3-4.0 (fatigue), 1.5-2.8 (pruritus); IRR: 1.8-5.8 (fatigue), 1.6-6.1 (pruritus); Cost difference: $42,515 (fatigue), $40,536 (pruritus)
Population: US patients with primary biliary cholangitis (1839 fatigue cases/controls, 760 pruritus cases/controls; mean age ~56, ~90% female)

Result:

PubMed: 42583941DOI: 10.57264/cer-2025-0179

Mechanism Graph

PBC is a chronic liver disease that can cause systemic symptoms like fatigue and pruritus.
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These symptoms may lead to increased psychological distress and sleep disruption.
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This results in higher rates of comorbidities such as anxiety, depression, and sleep disorders.
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Increased comorbidity burden leads to more healthcare visits and higher costs.

Limitations

  • ⚠Retrospective design using administrative claims data may have coding inaccuracies or misclassification of symptoms.
  • ⚠Matching may not fully control for unmeasured confounders (e.g., disease severity, lifestyle factors).
  • ⚠Generalizability limited to US patients with commercial insurance (IQVIA PharMetrics Plus).

Frequently Asked Questions

What is primary biliary cholangitis (PBC)?▼

PBC is a rare, long-term liver disease that can lead to other health problems and symptoms like fatigue and pruritus.

How much higher are healthcare costs for PBC patients with fatigue or pruritus?▼

Total healthcare costs were on average $42,515 higher for fatigue cases and $40,536 higher for pruritus cases compared to controls without these symptoms.

Which comorbidities are more common in PBC patients with fatigue or pruritus?▼

Anxiety, urinary tract infections, depression, and sleep disorders were significantly more common, with hazard ratios ranging from 1.3 to 4.0 for fatigue and 1.5 to 2.8 for pruritus.

What is the study design and population?▼

This was a retrospective matched case-control study using US claims data (2016-2022), including 1839 fatigue cases/controls and 760 pruritus cases/controls, mostly female with mean age around 56.

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References

  1. 1.Kumar S, Shamseddine N, Yang H, Zhang S, Chen J, Kowdley KV. "Burden of fatigue or pruritus in patients with primary biliary cholangitis: a United States matched case-control study.." Journal of comparative effectiveness research, 2026. PMID: 42583941 DOI: 10.57264/cer-2025-0179
Disclaimer: This content is for educational purposes only and is not medical advice. Evidence scores reflect the quality and quantity of available research, not clinical recommendations. Always consult a healthcare professional before starting any supplement or intervention.