Rifaximin-α in Patients With Recurrent Episodes of Hepatic Encephalopathy Due to Cirrhosis Reduces Healthcare Utilization

Abstract

Background and aims: Hepatic encephalopathy is a frequent complication of cirrhosis. Rifaximin-α has been included in guidelines for secondary prevention of hepatic encephalopathy, but there are few real-world data on its efficacy and impact on healthcare utilization. In this study, we aimed to assess the effect of rifaximin-α on healthcare utilization.

Method: We conducted a cohort analysis in patients from seven hospitals in the Netherlands, who received rifaximin-α as secondary prophylaxis for hepatic encephalopathy. Data were compared 6 months before and 6 months after the prescription of rifaximin-α. The primary endpoint was the effect of rifaximin-α on healthcare utilization. Secondary endpoint was the effect of rifaximin-α on healthcare costs.

Results: We included 126 patients (65% male; median age 68) with a median Model for End-stage Liver Disease score of 15. The mean number of hepatic encephalopathy episodes after starting rifaximin-α was lower than before starting rifaximin-α (0.9 vs. 2.2; p < 0.001). Mean healthcare utilization decreased from 6.1 contacts in the 6 months before rifaximin-α to 3.3 contacts in the 6 months after starting rifaximin-α (p < 0.001). The mean number of hospital admissions decreased from 1.7 admissions per patient to 1.0 admissions after starting rifaximin-α (p < 0.001). The mean number of outpatient visits also decreased after starting rifaximin-α (2.4 visits per patient to 1.7; p = 0.001). Annual costs per patient before starting rifaximin-α were €13,320. This was similar to the costs after rifaximin-α was prescribed (€13,120).

Conclusion: Rifaximin-α significantly reduced the number of episodes of hepatic encephalopathy, the number of hospital admissions as well as the number of outpatient and emergency department visits, contributing to a reduction in healthcare utilization. There was no reduction in overall costs.

Keywords: MELD; costs; hospital admissions; microbiome; microbiota; non‐adsorbable antibiotics; portal hypertension; prevention; prophylaxis; rifaximin.

FIGURE 1

Patient inclusion flowchart. TFS, transplant free survival.

FIGURE 2

Kaplan–Meier curve for transplant free survival in months after rifaximin prescription.

FIGURE 3

Number of episodes of HE 6 months before and 6 months after starting rifaximin. *p < 0.001.

FIGURE 4

Healthcare utilization (HU) 6 months before and 6 months after starting rifaximin. *p < 0.001.

FIGURE 5

Number of visits to hospital departments in 6 months before and 6 months after starting rifaximin. ER, emergency room; ns = not significant. *p < 0.001; **p = 0.001; ***p = 0.024.