Hospitalizations and healthcare costs associated with rifaximin versus lactulose treatment among commercially insured patients with hepatic encephalopathy in the United States

Abstract

View related articles View Crossmark dataHospitalizations and healthcare costs associated with rifaximin versus lactulose treatment among commercially insured patients with hepatic encephalopathy in the United States.

Overt Hepatic Encephalopathy: Current Pharmacologic Treatments and Improving Clinical Outcomes

“…An analysis of 2 US claims databases (N = 11,205) indicated that rifaximin (with or without lactulose) decreased absolute annual rates of hepatic encephalopathy-related admissions 33% to 34% compared with lactulose alone, irrespective of adherence to rifaximin (reduction of 49% to 51% vs lactulose alone). 31 Further, hepatic encephalopathy-related hospital days decreased 43% and 57% with rifaximin versus lactulose alone. 31 An analysis of data from a large US Medicare cohort of patients with cirrhosis and a diagnosis of hepatic encephalopathy (2008-2014; N = 49,164) supported the efficacy of hepatic encephalopathy prophylaxis to improve survival and hospitalization-related outcomes (Figure 2).…”

“…31 Further, hepatic encephalopathy-related hospital days decreased 43% and 57% with rifaximin versus lactulose alone. 31 An analysis of data from a large US Medicare cohort of patients with cirrhosis and a diagnosis of hepatic encephalopathy (2008-2014; N = 49,164) supported the efficacy of hepatic encephalopathy prophylaxis to improve survival and hospitalization-related outcomes (Figure 2). 22 More than half of patients (57.8%) received lactulose ≥ 90 days; 31.2% received rifaximin or lactulose < 90 days; and 19.6% received rifaximin monotherapy ≥ 90 days.…”

“…42 A US claims-based analysis (N = 11,205) showed that patients treated with rifaximin had decreased length of hospitalization versus patients treated with lactulose (adjusted IRR, 0.43 to 0.57) and decreased monthly medical costs (P < .001). 31 Further, a Dutch prospective study (N = 127) supported the benefit of long-term rifaximin treatment on hospital-related outcomes when comparing the 6 months prior to rifaximin treatment with the 6-month rifaximin treatment period (Table ). 38 An Australian noncomparative retrospective study (N = 188) reported that initiation of rifaximin in patients with hepatic encephalopathy at the time of hospitalization resolved symptoms within a median of 7 days in 70.7% of patients.…”

Changing Epidemiology of Cirrhosis and Hepatic Encephalopathy

“…A recent analysis by Volk et al using 2 large private insurance databases found an average cost of a hospital stay for HE of USD $29,063 to $34,810 during the study period (2014-2019). 69 Readmissions multiply the burden of hospitalization. HE is the strongest risk factor for readmission.…”

Is rifaximin better than nonabsorbable disaccharides in hepatic encephalopathy?

“…[ 19 , 20 ] Recent studies have pointed out that the total cost of hospitalization in patients with HE treated with rifaximin is not higher than that in the lactulose treatment group, indicating the high application potential of rifaximin in HE. [ 21 ]…”