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WHO:

Dr. Gish is a Hepatologist specializing in all forms of liver disease, liver cancer and liver transplant. Dr. Gish has partnered with TeleMed2U to provide telemedicine consultative services for patients with liver disease.

WHAT:

TeleMed2U is a telemedicine-based multi-specialty clinical practice increasing access to specialist providers providing, “healthcare anywhere and everywhere.” The telemedicine consultation will be conducted through our HIPAA and HITECH compliant platform. Connectivity testing will be done in advance to ensure you can connect via our telemedicine platform. Following the consultation, a clinical note will be provided including a summary of your liver consultation with Dr. Gish and his consultative recommendations.

COST:

Payment will be processed through an online secure transaction portal. The fees for consultative services are:

Initial 60 minute consultation per patient: $500.00
Follow Up 30 minute consultation per patient: $300.00

NEXT STEPS:

If you’d like to continue, please click Next to complete the form and we will contact you to schedule connectivity testing. During the test you will have the opportunity to determine the method of providing medical records, discuss appointment availability as well as discuss any additional questions that you have. If you are a healthcare facility interested in services, please complete the form and we can discuss the options that are right for you and your patients.

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E-mail correspondence with Dr. Robert G. Gish Consultants, LLC or any of its employees, or agents, does not create a physician/patient relationship between us or cause Dr. Gish to create or retain any medical records about you, monitor your care, or communicate with your own health care provider.

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Pruritus, Healthcare Utilization and Costs Among Individuals With PBC

May 11, 2026

Association Between Pruritus and Healthcare Utilization and Costs Among Individuals With Primary Biliary Cholangitis

ABSTRACT

Background and Aims: Pruritus is a debilitating, under-prioritized symptom of primary biliary cholangitis (PBC). This study assessed its impact on healthcare resource utilization (HCRU) and costs in the US.

Methods: A retrospective cohort study of individuals with PBC was conducted using Komodo’s claims and laboratory data between September 1, 2017 and September 30, 2023. Individuals’ index date was a randomly selected medical event with (cases) or without pruritus diagnosis (controls) after initial PBC diagnosis. Participants were ≥ 18 years old with continuous insurance eligibility for ≥ 12 months before and after their index, excluding those on obeticholic acid during baseline. Negative binomial models estimated HCRU rate ratios, and linear models estimated incremental all-cause total costs (2024 USD) associated with pruritus, adjusting for baseline demographics and clinical characteristics.

Results: 10 077 patients with PBC and pruritus and 41 957 controls (PBC only) were identified. Regression-adjusted HCRU rate ratios for pruritus vs. controls were 1.69 (inpatient), 1.36 (outpatient), 1.65 (emergency), and 1.44 (prescription counts) and one-year adjusted healthcare costs averaged $39 949 for pruritus and $25 695 for controls, with an incremental cost of $14 254 (all p < 0.001). In sensitivity analyses, incremental costs ranged from $11 495 (using a broader definition of pruritus diagnosis or treatment) to $27 669 (using a stricter definition of pruritus diagnosis and treatment within ±90 days of diagnosis; both p < 0.001).

Conclusion: Pruritus significantly increases HCRU and costs in PBC, highlighting the economic argument for improved management. Further research should assess the effectiveness of novel PBC therapies in slowing liver disease progression and mitigating pruritus symptoms concomitantly.

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