Background: Hepatic encephalopathy (HE) is a common neurological complication in patients with cirrhosis. In addition to numerous morbidity-related issues, HE is associated with substantial economic burden. Treatment includes lactulose or rifaximin, a nonsystemic antibiotic that is indicated for reducing the risk of overt HE recurrence in adults. Rifaximin has also been shown to reduce the risk of overt HE-related hospitalization in patients with a history of overt HE as well as readmission in those hospitalized for HE. The aim of this systematic analysis is to provide an overview of direct HE-related costs and potential cost benefits of rifaximin, lactulose, and rifaximin plus lactulose.
Methods: A systematic review of PubMed and relevant congress abstracts (Jan 1, 2007 through Jun 23, 2017) was performed to identify publications reporting economic data related to HE and rifaximin and/or lactulose. Further, data from the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project (HCUPnet) and published literature were used to estimate current costs of hospitalization for overt HE and potential cost savings of HE-related hospitalizations with rifaximin. Data from the National Health and Nutrition Examination Survey (1999–2010) and published literature were also used to estimate the prevalence of overt HE in patients with cirrhosis and the number of patients with overt HE using rifaximin and/or lactulose who might experience recurrence of HE or an HE-related hospitalization. Total HE-related hospitalization costs were derived using the calculated number of patients anticipated to experience HE-related hospitalization and HCUPnet data from 2014 (all-cause hospitalization costs). These data were used to estimate the cost savings for avoided hospitalizations in patients receiving rifaximin with lactulose versus lactulose alone, assuming all patients received lactulose (incremental costs of therapy were not factored into this cost savings calculation).
Results: A total of 16 reports were identified for inclusion in the systematic analysis. Globally, mean HE-related direct costs ranged from $5,370–$50,120 annually per patient. Treatment with rifaximin was associated with decreased duration of hospital stays and reduced healthcare costs. In one US study, rifaximin plus lactulose significantly reduced the odds of rehospitalization within 30 days for patients with overt HE (adjusted odds ratio, 0.39; 95% CI, 0.16–0.87; P=0.02). Potential annual HE-related cost savings with rifaximin plus lactulose in the United States were estimated at $25 to $49 million and related to a decrease in patient hospitalizations compared with lactulose alone. Rifaximin plus lactulose demonstrated a favorable pharmacoeconomic profile compared with lactulose alone.
Conclusions: Economic data are favorable for the use of rifaximin in reducing the risk of hospital readmission due to overt HE. Rifaximin should be considered at discharge in adults with cirrhosis hospitalized due to overt HE.
Support for abstract preparation provided by Salix Pharmaceuticals.