a Pharmatelligence , Cardiff , UK.
b Norgine Pharmaceuticals Limited , Harefield, Uxbridge , UK.
Curr Med Res Opin. 2018 Nov;34(11):2001-2008. doi: 10.1080/03007995.2018.1499506. Epub 2018 Aug 13.
Rifaximin-α 550 mg twice daily plus lactulose has demonstrated efficacy in reducing recurrence of episodes of overt hepatic encephalopathy (OHE) and the risk of hepatic encephalopathy (HE)-related hospitalizations compared with lactulose alone. This analysis estimated the cost effectiveness of rifaximin-α 550 mg twice daily plus lactulose versus lactulose alone in United Kingdom (UK) cirrhotic patients with OHE.
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 was sourced from a randomized controlled trial (RCT) and an open-label maintenance 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 was from four single-center UK audits. Costs (2012) were derived from published sources; costs and benefits were discounted at 3.5%. The base-case time horizon was 5 years.
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 quality adjusted life years (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.
Rifaximin-α 550 mg twice daily in patients with recurrent episodes of OHE was estimated to generate cost savings and improved clinical outcomes compared to standard care over 5 years.
与单独使用乳果糖相比，利福昔明-α 550mg，每日两次联合乳果糖可降低显性肝性脑病（OHE）发作的复发率和肝性脑病（HE）相关住院风险。本分析评估了利福昔明-α 550mg，每日两次联合乳果糖与单独使用乳果糖治疗英国（UK）肝硬化伴 OHE 患者的成本效果。
建立 Markov 模型以估计增量成本效果比（ICER）。该分析的观点是英国国家医疗服务体系（NHS）的观点。临床数据来源于一项随机对照试验（RCT）和一项开放标签维持研究，纳入的是缓解复发性 OHE 发作的肝硬化患者。健康相关效用通过来自特定疾病生活质量 RCT 数据的间接方法来估计。描述利福昔明-α对肝硬化伴 OHE 患者住院和住院时间影响的资源使用数据来自四项英国单中心审计。成本（2012 年）来自已发表的资料；成本和效益以 3.5%贴现。基本情况的时间范围为 5 年。
利福昔明-α联合乳果糖组患者的平均每人费用为 22971 英镑，乳果糖组为 23545 英镑，节省了 573 英镑。相应的效益值为 2.35 个质量调整生命年（QALY）和每人 1.83 个 QALY，差值为 0.52 QALY。这转化为基本情况的主导 ICER。影响 ICER 的关键参数包括住院次数和住院时间。
与标准治疗相比，利福昔明-α 550mg，每日两次治疗复发性 OHE 患者在 5 年内估计可节省成本并改善临床结局。
