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Cost-Effectiveness of Rifaximin Treatment in Patients with Hepatic Encephalopathy

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 mains...

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Autores principales: Jesudian, Arun B., Ahmad, Maliha, Bozkaya, Duygu, Migliaccio-Walle, Kristen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Academy of Managed Care Pharmacy 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10391162/
https://www.ncbi.nlm.nih.gov/pubmed/32463782
http://dx.doi.org/10.18553/jmcp.2020.26.6.750
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author Jesudian, Arun B.
Ahmad, Maliha
Bozkaya, Duygu
Migliaccio-Walle, Kristen
author_facet Jesudian, Arun B.
Ahmad, Maliha
Bozkaya, Duygu
Migliaccio-Walle, Kristen
author_sort Jesudian, Arun B.
collection PubMed
description 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 quality-adjusted 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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spelling pubmed-103911622023-08-02 Cost-Effectiveness of Rifaximin Treatment in Patients with Hepatic Encephalopathy Jesudian, Arun B. Ahmad, Maliha Bozkaya, Duygu Migliaccio-Walle, Kristen J Manag Care Spec Pharm Research 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 quality-adjusted 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. Academy of Managed Care Pharmacy 2020-06 /pmc/articles/PMC10391162/ /pubmed/32463782 http://dx.doi.org/10.18553/jmcp.2020.26.6.750 Text en Copyright © 2020, Academy of Managed Care Pharmacy. All rights reserved. https://creativecommons.org/licenses/by/4.0/This article is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use and redistribution provided that the original author and source are credited.
spellingShingle Research
Jesudian, Arun B.
Ahmad, Maliha
Bozkaya, Duygu
Migliaccio-Walle, Kristen
Cost-Effectiveness of Rifaximin Treatment in Patients with Hepatic Encephalopathy
title Cost-Effectiveness of Rifaximin Treatment in Patients with Hepatic Encephalopathy
title_full Cost-Effectiveness of Rifaximin Treatment in Patients with Hepatic Encephalopathy
title_fullStr Cost-Effectiveness of Rifaximin Treatment in Patients with Hepatic Encephalopathy
title_full_unstemmed Cost-Effectiveness of Rifaximin Treatment in Patients with Hepatic Encephalopathy
title_short Cost-Effectiveness of Rifaximin Treatment in Patients with Hepatic Encephalopathy
title_sort cost-effectiveness of rifaximin treatment in patients with hepatic encephalopathy
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10391162/
https://www.ncbi.nlm.nih.gov/pubmed/32463782
http://dx.doi.org/10.18553/jmcp.2020.26.6.750
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