Introduction Overt Hepatic Encephalopathy (HE) frequently results in emergency admission to hospital. Treatment with the non-absorbable antibiotic rifaximin is effective at preventing recurrence of overt HE but there are concerns about the high cost of the drug. The aim of this study was to evaluate the cost-effectiveness of rifaximin at reducing emergency admission to hospital.
Methods All patients commenced on rifaximin for HE from 1st January to 31st December 2011 were identified from the records of the pharmacy department at Freeman Hospital. The number and length of emergency hospital admissions for the period 1 year prior to starting rifaximin was compared to 1 year after starting the drug. Cost effectiveness was calculated using the standard British National Formulary (BNF) tariff for rifaximin and the estimated cost per day for acute inpatient admission to the Newcastle upon Tyne Hospitals Trust.
Results 64 patients (75% male, 53% ALD) were identified, 40 (63%) were on concomitant lactulose. In 8 patients rifaximin was discontinued (5 after transplant and 3 when HE excluded). 23 (36%) patients died within 1 year (median survival 62 days (range 2–364) and 33 (52%) were alive at 1 year and remained on rifaximin. Mean MELD of survivors was significantly lower than non-survivors (13.0 vs. 19.0 P < 0.05) and scores predicted 28 day mortality (median MELD 29 (range 4–37)). Complete data were available for 25 of the survivors and showed a significant reduction in the number of emergency admissions from a mean of 2.8 to 1.7 admissions per patient per year with rifaximin (P < 0.05). Duration of inpatient admission decreased significantly from a mean of 30.2 to 9.8 bed days per patient per year (P < 0.05). Taking into account the cost of one year’s treatment with rifaximin (£3,687GBP) the reduction in the number of emergency admissions represents an annual saving of £3,468GBP per patient.
Conclusion Treatment with rifaximin for secondary prevention of hepatic encephalopathy appears to be cost effective at reducing emergency admission to hospital.
Disclosure of Interest None Declared
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