Introduction Rifaximin is a minimally absorbed, gut-selective antibiotic, which is safe and effective in the prevention and treatment of Hepatic Encephalopathy (HE). However, it is expensive and there is debate regarding its cost effectiveness.
Aim The present study examines the impact of Rifaximin treatment on hospital admissions and hospital bed day occupancy in patients with recurrent HE, due to chronic liver disease.
Methods Medical records of all 30 hospital patients with HE, commenced on Rifaximin between November 2011 and May 2013, in a District General Hospital, were evaluated. Data were collected on patient demographics, MELD scores, number of hospital admissions, bed day occupancy for each admission, and concomitant therapy for HE. We compared the clinical features and diagnoses for the number of, and length of each hospital admission for the 6 months before, and 6 months after, commencing Rifaximin treatment.
Results 30 patients with HE (18 men, 12 women), median age 64 (Inter-quartile range (IQR) 51–67), were commenced on Rifaximin. 83% had Alcohol-related liver disease, 10% NASH and 7% Hepatitis C. Median MELD score was 15.5 (IQR 13.5–21). All patients were prescribed lactulose. Of the 30 patients, 5 died within 6 months of commencing Rifaximin. One patient was discontinued, due to non-compliance. 24 patients were included in the final analysis. We compared the outcomes for the 6 months prior to, and the 6 months after commencing Rifaximin treatment. Median hospital admissions were reduced from 2 admissions (IQR 1–3, Range 1–5) to 1 admission (IQR 0–2, Range 0–4, Wilcoxon p < 0.05). Median number of bed days was reduced from 27.5 (IQR 16.0–35.3, Range 2–129) to 2.5 (IQR 0–23.5, Range 0–55, Wilcoxon p < 0.05). No patient developed Clostridium difficile-associated diarrhoea in the 6 months after commencing Rifaximin.
Conclusion In our hospital, the basic cost of a hospital bed day is £300. A 6 month course of Rifaximin costs £1688. This study demonstrates that Rifaximin treatment in patients with HE, due to chronic liver disease, produced a marked reduction in hospital admissions and hospital bed day occupancy in a District General Hospital, with major cost savings and improved clinical outcomes.
Disclosure of Interest None Declared.