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PWE-153 Cost Effectiveness Of Rifaximin-a In The Reduction Of Recurrence Of Overt Hepatic Encephalopathy
  1. CD Poole1,
  2. P Conway2,
  3. K Nanuwa3,
  4. B Joseph2,
  5. C Bannister1,
  6. CJ Currie1
  1. 1School of Medicine, Cardiff University, Cardiff, UK
  2. 2Norgine Global Health Outcomes, Norgine Ltd, UK
  3. 3Norgine UK, Uxbridge, UK

Abstract

Introduction Hepatic encephalopathy (HE) is associated with high morbidity and mortality. Rifaximin-α is effective in reducing the recurrence of episodes of overt HE. The aim was to characterise the cost effectiveness of rifaximin-α versus standard care (lactulose).

Methods This economic evaluation used a Markov state transition model. The outcome was the incremental cost effectiveness ratio (ICER), derived from estimates of the cost/quality adjusted life years. The payer perspective was that of UK National Health Service. Outcome data were from two trials of rifaximin-α. Population outcome data were from a complementary study of patients with liver cirrhosis treated within the NHS. Cost data (GBP£2012) were derived from published sources. Health-related utility was estimated indirectly from disease-specific trial QoL data. The time horizon was five years. Costs and benefits were discounted at 3.5%. Extensive sensitivity analysis was carried out.

Results The average cost of the included elements of care was £15,476 in the rifaximin-α arm and £4,486 in the lactulose arm, a difference of £10,990. The corresponding values for benefit was 2.36 QALYs, and 1.83 QALYs per person, respectively; a difference of 0.53 units. This translated into a base-case ICER of £20,852/QALY. Key parameters that impacted the ICER included the event-free survival pattern, ranging from an ICER of £13,919 using an exponential model, to £21,425/QALY using a log-logistic model. Evaluation to 10 years resulted in an ICER of £19,122/QALY.

Conclusion Rifaximin-α in patients with liver cirrhosis was cost effective compared to standard care, reducing episodes of overt hepatic encephalopathy.

Disclosure of Interest C. Poole Consultant for: Norgine, P. Conway Employee of: Norgine;, K. Nanuwa Employee of: Norgine, B. J, oseph Employee of: Norgine, C. Bannister Consultant for: Norgine, C. Currie Consultant for: Norgine.>

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