Update on Management of Patients With Overt Hepatic Encephalopathy

Chacko, Kristina; Sigal, Samuel H.

doi:10.3810/hp.2013.08.1068

Cited by 4 publications

(7 citation statements)

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“…HE has a substantial economic effect, not only owing to the direct costs of its management (particularly HE-related hospitalization) but also to the indirect costs arising from, for example, absence from work and loss of work productivity 1,6,7. HE negatively affects the lives of both patients and caregivers 1,8 and the socioeconomic implications of HE over the longer term may be very profound, decreasing work performance, increasing the risk of vehicle accidents and severely impairing quality of life 1.…”

Section: Introductionmentioning

confidence: 99%

Long-term management of hepatic encephalopathy with lactulose and/or rifaximin: a review of the evidence

Hudson

Schuchmann²

2019

European Journal of Gastroenterology &Amp; Hepatology

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A consolidated overview of evidence for the effectiveness and safety/tolerability of hepatic encephalopathy (HE) treatment over the long term is currently lacking. We identified and assessed published evidence for the long-term (≥6 months) pharmacological management of HE with lactulose and/or rifaximin. A literature search was conducted in PubMed (cutoff date 05 March 2018) using the search terms ‘hepatic encephalopathy+rifaximin’ and ‘hepatic encephalopathy+lactulose’. All articles containing primary clinical data were manually assessed to identify studies in which long-term (≥6 months) effectiveness and/or safety/tolerability end points were reported for lactulose and/or rifaximin. Long-term effectiveness outcomes were reported in eight articles for treatment with lactulose alone and 19 articles for treatment with rifaximin, alone or in combination with lactulose. Long-term safety/tolerability outcomes were reported in six articles for treatment with lactulose alone and nine articles for treatment with rifaximin, alone or in combination with lactulose. These studies showed that lactulose is effective for the prevention of overt HE recurrence over the long term and that the addition of rifaximin to lactulose significantly reduces the risk of overt HE recurrence and HE-related hospitalization, compared with lactulose therapy alone, without compromising tolerability. Current evidence therefore supports recommendations for the use of lactulose therapy for the prevention of overt HE recurrence over the long term, and for the additional benefit of adding rifaximin to lactulose therapy. Addition of rifaximin to standard lactulose therapy may result in substantial reductions in healthcare resource utilization over the long term, by reducing overt HE recurrence and associated rehospitalization.

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Section: Introductionmentioning

confidence: 99%

Long-term management of hepatic encephalopathy with lactulose and/or rifaximin: a review of the evidence

Hudson

Schuchmann²

2019

European Journal of Gastroenterology &Amp; Hepatology

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“…8 The number of hospital discharges associated with HE based on codes from the International Classification of Diseases, Ninth Revision, Clinical Modification has progressively increased since 2004 and exceeded 400,000 in 2010. 9 , 10 Based on the Nationwide Inpatient Sample, the estimated hospitalization incidence for patients with HE as a primary or secondary diagnosis ranged from 102,293 in 2005 to 115,814 in 2009; the prevalence was 0.33% of all hospitalizations. 11 Although hospitalizations related to HE have been increasing, for patients with a primary diagnosis of HE, the mean length of stay decreased between 1993 and 1996 in the USA and has subsequently remained constant at approximately 6 days.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the impact of rehospitalization in the management of hepatic encephalopathy

Saab¹

2015

IJGM

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BackgroundOvert hepatic encephalopathy (HE), which is associated with neuropsychiatric symptoms and neuromuscular dysfunction in patients with liver cirrhosis, is often managed in the hospital setting. Approximately 60% of eligible patients do not receive prophylactic therapy after an overt HE episode.ObjectiveThe aim of this review is to evaluate the impact of rehospitalization on costs and clinical outcomes in HE.MethodsA PubMed search of English-language articles through July 9, 2014 was conducted, and bibliographies of identified publications were reviewed. Abstracts from relevant professional society meetings from 2010 to 2014 were searched. The selected references and abstracts reported on the prevalence, costs, or clinical consequences of rehospitalization in adults with HE.Data synthesisHE is a key reason for readmission among patients hospitalized for complications of cirrhosis. Almost 40% of patients previously hospitalized for HE may be readmitted within 1 year for HE-related reasons. Furthermore, in-hospital US mortality for patients admitted for HE is about 7% to 15%. Recurrent HE and hospitalization for cirrhosis complications are associated with impaired quality of life. In addition, recurrences (especially those requiring hospitalization) may contribute to persistent cognitive deficits (eg, impairments in reaction time, attention, and working memory) after resolution of an acute episode of overt HE.ConclusionThe economic and clinical consequences of rehospitalization for patients with overt HE underscore the importance of secondary prevention and highlight the need to identify reasons for the undertreatment of patients after hospitalization for overt HE.

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“…Using Microsoft Excel, a cost-effectiveness model was created to predict costs and outcomes of patients with HE after In addition, lactulose is associated with unpleasant or sweet taste, dehydration, and gastrointestinal adverse events (AEs), such as diarrhea, nausea, bloating, and gas, 6,14 which may lead to medication nonadherence. 16 Given these concerns, additional HE therapies with a more favorable AE profile have been investigated in the treatment of overt HE.…”

Section: ■■ Methodsmentioning

confidence: 99%

“…5 Clinical manifestations of overt HE include generalized psychomotor dysfunction with alterations in consciousness. 6 Episodes of overt HE may result in increased health care resource utilization and can affect quality of life of both patients and families. 7,8 After an initial episode of overt HE, secondary prophylaxis is recommended to decrease the risk of recurrence, which is considered preventable with proper prophylaxis.…”

mentioning

confidence: 99%

“…[9][10][11][12] Lactulose has historically been used as first-line therapy for acute HE and for maintenance of remission. 6,13,14 Use of lactulose as a maintenance medication may be limited because of a lack of randomized, placebo-controlled trials to determine efficacy. 14,15 • Hepatic encephalopathy (HE) is a complication of significant liver disease that causes neuropsychiatric abnormalities and results in increased health care resource utilization.…”

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confidence: 99%

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Cost-Effectiveness of Rifaximin Treatment in Patients with Hepatic Encephalopathy

Jesudian

Ahmad²,

Bozkaya³

et al. 2020

JMCP

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BACKGROUND: Hepatic encephalopathy (HE) is a complication of cirrhosis of the liver causing neuropsychiatric abnormalities. Clinical manifestations of overt HE result in increased health care resource utilization and effects on patient quality of life. While lactulose has historically been the mainstay of treatment for acute HE and maintenance of remission, there is an unmet need for additional therapeutic options with a favorable adverse event profile. Compared with lactulose alone, rifaximin has demonstrated proven efficacy in complete reversal of HE and reduction in the incidence of HE recurrence, mortality, and hospitalizations. Evidence suggests the benefit of long-term prophylactic therapy with rifaximin; however, there is a need to assess the economic impact of rifaximin treatment in patients with HE. OBJECTIVE: To assess the incremental cost-effectiveness of rifaximin ± lactulose versus lactulose monotherapy in patients with overt HE.METHODS: A Markov model was developed in Excel with 4 health states (remission, overt HE, liver transplantation, and death) to predict costs and outcomes of patients with HE after initiation of maintenance therapy with rifaximin ± lactulose to avoid recurrent HE episodes. Cost-effectiveness of rifaximin was evaluated through estimation of incremental cost per qualityadjusted life-year (QALY) or life-year (LY) gained. Analyses were conducted over a lifetime horizon. One-way deterministic and probabilistic sensitivity analyses were conducted to assess uncertainty in results. RESULTS:The rifaximin ± lactulose regimen provided added health benefits despite an additional cost versus lactulose monotherapy. Model results showed an incremental benefit of $29,161 per QALY gained and $27,762 per LY gained with rifaximin ± lactulose versus lactulose monotherapy. Probabilistic sensitivity analyses demonstrated that the rifaximin ± lactulose regimen was cost-effective ~99% of the time at a threshold of $50,000 per QALY/LY gained, which falls within the commonly accepted threshold for incremental cost-effectiveness. CONCLUSIONS:The clinical benefit of rifaximin, combined with an acceptable economic profile, demonstrates the advantages of rifaximin maintenance therapy as an important option to consider for patients at risk of recurrent HE.

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Update on Management of Patients With Overt Hepatic Encephalopathy

Cited by 4 publications

References 89 publications

Long-term management of hepatic encephalopathy with lactulose and/or rifaximin: a review of the evidence

Long-term management of hepatic encephalopathy with lactulose and/or rifaximin: a review of the evidence

Evaluation of the impact of rehospitalization in the management of hepatic encephalopathy

Cost-Effectiveness of Rifaximin Treatment in Patients with Hepatic Encephalopathy

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