Background and AimsThe clinical sequelae and comorbidities of alcoholic liver disease (ALD) often require hospitalization. The aims of this study were to (1) compare the average costs of hospitalizations with ALD and the costs of hospitalizations with other alcohol-related diagnoses that do not involve the liver; and (2) estimate the percentage of the difference in costs between the ALD and non-ALD hospitalizations that may be attributed to ascites, protein-calorie malnutrition and other conditions. DesignThe 2012 National Inpatient Sample is a population-based cross-sectional database representing more than 94% of all discharges from community hospitals in the United States. SettingCommunity hospitals in the United States. ParticipantsThe sample included 72531 hospitalizations with ALD and 287047 hospitalizations with other alcohol-related diagnoses. MeasurementsThe dependent variable was total in-patient costs. We estimated the contribution of ascites, protein-calorie malnutrition and other conditions to the difference in costs between patients with ALD and patients with other diagnoses. FindingsAverage costs for ALD patients were $3188.4 higher than those for patients with other diagnoses ($13543 versus $10355; P<0.001). Among all conditions in the analysis, protein-calorie malnutrition had the largest impact on costs [$6501; 95% confidence interval (CI)=5956, 7045; P<0.001] accounting for 12% of the higher costs of ALD stays. ConclusionsCosts of hospital care for patients with alcoholic liver disease are higher than those for patients with other alcohol-related diagnoses. These increased costs are associated with specific clinical sequelae and comorbidities, with protein-calorie malnutritiona largely preventable conditionmaking a substantial contribution.