Impact of rifaximin use following an initial overt hepatic encephalopathy hospitalization on rehospitalization and costs.
J Med Econ
; 26(1): 1169-1177, 2023.
Article
em En
| MEDLINE
| ID: mdl-37664993
ABSTRACT
AIM:
To assess the impact of rifaximin (± lactulose) use following discharge of an initial overt hepatic encephalopathy (OHE) hospitalization on OHE rehospitalizations and healthcare costs in a real-world setting.METHODS:
Adults (18-64 years) with an OHE hospitalization were identified from MarketScan® Commercial claims (Q4'15-Q2'20), classified into two mutually exclusive treatment cohorts (i.e. rifaximin and no rifaximin treatment), and further stratified into four subgroups based on decreasing quality of care (QoC; i.e. Type 1 - rifaximin without delay post-discharge; Type 2 - rifaximin with delay post-discharge; Type 3 - lactulose only post-discharge; Type 4 - no rifaximin/lactulose treatment post-discharge). The impact of rifaximin use on 30-day and annualized OHE hospitalizations and healthcare costs were assessed between cohorts and by the QoC subgroup.RESULTS:
Characteristics were similar between the rifaximin (N = 1,452; Type 1 1,138, Type 2 314) and no rifaximin (N = 560; Type 3337, Type 4 223) treatment cohorts. The 30-day risk of OHE rehospitalization was lower for the rifaximin vs. no rifaximin treatment cohort (odds ratio 0.56, p < .01) and increased with decreasing QoC. The annual rate of OHE hospitalizations was 59% lower for the rifaximin treatment cohort (incidence rate ratio 0.41, p < .01) and increased with decreasing QoC. Compared to the no rifaximin treatment cohort, the rifaximin treatment cohort had higher pharmacy costs, lower medical costs, and no difference in total healthcare costs.LIMITATIONS:
This was a claims-based study subject to common data limitations such as billing inaccuracies or omissions in coded claims. Total healthcare costs were reported from a payer's perspective, which do not capture indirect costs associated with patient burden.CONCLUSIONS:
Initiation of rifaximin after an OHE hospitalization was associated with reduced OHE hospitalizations both in the 30-days following and annually. Further, reduced medical costs offset increased pharmacy costs, and no annual cost differences were observed between cohorts.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Encefalopatia Hepática
Tipo de estudo:
Health_economic_evaluation
/
Prognostic_studies
Limite:
Adult
/
Humans
Idioma:
En
Revista:
J Med Econ
Assunto da revista:
SERVICOS DE SAUDE
Ano de publicação:
2023
Tipo de documento:
Article
País de afiliação:
Estados Unidos