The impact of rifaximin-α on the hospital resource use associated with the management of patients with hepatic encephalopathy: a retrospective observational study (IMPRESS)

Abstract

ObjectiveTo compare all-cause and liver-related hospital resource use in the 6 and 12 months pre-rifaximin-α and post-rifaximin-α initiation in UK patients with hepatic encephalopathy (HE).DesignA UK multicentre, retrospective, observational study. Patients' medical records were reviewed for demographics, clinical outcomes and adverse events (AEs) to rifaximin-α. Details of hospital admissions/attendances in the 6 and 12 months pre-rifaximin-α and post-rifaximin-α initiation were extracted from hospital electronic databases.Setting13 National Health Service centres.Patients207 patients with HE who initiated rifaximin-α between July 2008 and May 2014. Hospital resource use data were available for 145/207 patients.Main outcome measureChange in mean number of liver-related hospital bed days/patient (total and critical care) between the 6 months pre-rifaximin-α and post-rifaximin-α initiation.ResultsComparing the 6 months pre-rifaximin-α and post-rifaximin-α initiation in alive patients at the end of the observation period (N=114): there were significant reductions in the mean number of hospitalisations/patient (liver-related 1.3 to 0.5, p<0.001; all-cause 1.9 to 0.9, p<0.001), hospital bed days/patient (liver-related 17.8 to 6.8, p<0.001; all-cause 25.4 to 10.6, p<0.001), 30-day hospital readmissions/patient (liver-related 0.5 to 0.2, p=0.039; all-cause 0.8 to 0.4, p=0.024) and emergency department (ED) attendances/patient (all-cause, 1.0 to 0.5, p<0.001). The mean critical care bed days/patient reduced significantly for all-cause admissions (1.3 to 0.3, p=0.049); non-significant reduction for liver-related admissions. 4% of patients (9/207) developed AEs.ConclusionsIn UK clinical practice, treatment with rifaximin-α for HE is well-tolerated and associated with significant reductions in hospitalisations, bed days (including critical care), ED attendances and 30-day readmissions.

Rifaximin reduces the incidence of spontaneous bacterial peritonitis, variceal bleeding and all‐cause admissions in patients on the liver transplant waiting list

“…There is now a robust evidence base to support rifaximin as a beneficial adjunctive therapy to lactulose in the prevention of recurrent episodes of overt HE, reducing the risk of hospitalisation and lowering inpatient length of stay and healthcare resource utilisation . Furthermore, it has been shown to improve health‐related quality of life in patients with cirrhosis and overt HE in remission and has been demonstrated to be safe and well tolerated in patients for long‐term maintenance of remission from overt HE .…”

“…We did not observe a significant difference in hospital bed days, 8 in the rifaximin group vs 14 in the naïve group (mean effect estimate −6 [95% CI −12.23 to 0.76] days) and intensive care bed days, 1 in the rifaximin group vs 2 (mean effect estimate −1.40 [95% CI −3.76 to 0.97] days) in the naïve group. Moreover, recently published ‘real‐world' studies have shown that treatment with rifaximin was associated with a reduction in length of hospital stay and provides good value for money in terms of health economics and resource utilisation …”

“…Whilst the specific mechanism of action of rifaximin remains to be elucidated, it has been postulated to reduce circulating levels of gut‐derived endotoxins resulting from bacterial translocation . In clinical practice, treatment with rifaximin has been associated with significant reductions in hospitalisation, bed days (including critical care), emergency department attendances and 30‐day readmissions . However, there is a paucity of data on the impact of rifaximin on outcomes in patients with end‐stage liver disease.…”

“…9 In clinical practice, treatment with rifaximin has been associated with significant reductions in hospitalisation, bed days (including critical care), emergency department attendances and 30-day readmissions. 10,11 However, there is a paucity of data on the impact of rifaximin on outcomes in patients with end-stage liver disease.…”

Rifaximin treatment for encephalopathy reduces hospital resource use: real-world data don’t fail to IMPRESS

“…The current study by Hudson and colleagues, entitled the ‘IMPRESS’ study, represents further retrospective analysis of the impact of rifaximin on hospital resource use, this time from 13 sites around the UK 5. The purpose of the study was to provide ‘real-world’ data on the types and lengths of hospital admissions in patients who initiated rifaximin therapy for HE.…”