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Evaluation of the cost-effectiveness of rifaximin-α for the management of patients with hepatic encephalopathy in the United Kingdom

Berni, Ellen, Murphy, Daniel, Whitehouse, James, Conway, Pete, Di Maggio, Paola, Currie, Craig J. and Poole, Chris 2018. Evaluation of the cost-effectiveness of rifaximin-α for the management of patients with hepatic encephalopathy in the United Kingdom. Current Medical Research and Opinion 34 (11) , pp. 2001-2008. 10.1080/03007995.2018.1499506

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Objective: Rifaximin-α 550 mg twice daily plus lactulose has demonstrated efficacy in reducing recurrence of episodes of overt HE (OHE) and the risk of HE-related hospitalisations compared with lactulose alone. This analysis estimated the cost effectiveness of rifaximin-α 550 mg twice daily plus lactulose versus lactulose alone in UK cirrhotic patients with OHE. Method: A Markov model was built to estimate the incremental cost effectiveness ratio (ICER). The perspective was that of the UK National Health Service (NHS). Clinical data were sourced from a randomised controlled trial (RCT) and an open-label maintenance (OLM) study in cirrhotic patients in remission from recurrent episodes of OHE. Health-related utility was estimated indirectly from disease-specific quality of life RCT data. Resource use data describing the impact of rifaximin-α on hospital admissions and length of stay for cirrhotic patients with OHE were from four single-centre UK audits. Costs (2012) were derived from published sources; costs and benefits were discounted at 3.5%. The base-case time horizon was five years. Results: The average cost per patient was £22,971 in the rifaximin-α plus lactulose arm and £23,545 in the lactulose arm, a saving of £573. The corresponding values for benefit were 2.35 QALYs and 1.83 QALYs per person, a difference of 0.52 QALYs. This translated into a dominant base-case ICER. Key parameters that impacted the ICER included number of hospital admissions and length of stay. Conclusion: Rifaximin-α 550 mg twice daily in patients with recurrent episodes of overt HE was estimated to generate cost savings and improved clinical outcomes compared to standard care over five years.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: Taylor & Francis: STM, Behavioural Science and Public Health Titles
ISSN: 0300-7995
Date of First Compliant Deposit: 16 July 2018
Date of Acceptance: 15 February 2018
Last Modified: 12 Mar 2020 15:51

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