Transplant Institute, Loma Linda University Medical Center, Loma Linda, CA, USA.
Analysis Group, Inc, Montreal, Canada.
J Med Econ. 2021 Jan-Dec;24(1):202-211. doi: 10.1080/13696998.2021.1877148.
To assess healthcare costs and hospitalization rates associated with rifaximin therapy versus lactulose alone among patients at risk for hepatic encephalopathy (HE).
IBM Marketscan Commercial and Optum's de-identified Clinformatics Data Mart databases were used separately to identify commercially insured HE patients treated with rifaximin or lactulose alone, using an algorithm developed with clinical experts. HE-related hospitalizations were defined based on an algorithm using diagnosis codes and diagnosis-related group codes. HE-related/all-cause hospital admissions/days and healthcare costs were compared between rifaximin and lactulose episodes using incidence rate ratios and adjusted cost differences.
In Marketscan, there were 13,515 [Optum: 5,217] rifaximin episodes and 9,946 [4,897] lactulose alone episodes included. Yearly rates of HE-related hospital admissions decreased by 33% [34%] when treated with rifaximin versus lactulose alone, and rates of HE-related hospital days similarly decreased by 43% [57%]. Yearly rates of all-cause hospital admissions decreased by 27% [27%]; rates of all-cause hospital days decreased by 33% [37%] during rifaximin episodes versus lactulose alone. This translated to $2,417 [$2,301] and $173 [$397] lower total mean medical costs and HE-related hospital costs per-patient-per-month, respectively ( < .05). Despite increased pharmacy costs associated with rifaximin, there was no change in total healthcare costs. Patients adherent to rifaximin incurred $2,891 [$2,340] lower total healthcare costs than non-adherent patients. In a simulated plan of 1 million lives, if 50% of HE patients treated with lactulose alone had rifaximin added on and were adherent to rifaximin therapy, the total cost savings would be $7.5 [$6.1] million per year ($0.62 [$0.50] per-member-per-month).
Patients incurred significantly lower rates of HE-related and all-cause hospitalizations during rifaximin versus lactulose episodes, resulting in lower facility and professional costs. Cost savings may be possible if rifaximin adherence is improved in HE patients.
The study is subject to limitations common to claims-based analyses.
评估利福昔明治疗与乳果糖单药治疗肝性脑病（HE）高危患者的医疗保健成本和住院率。
分别使用 IBM Marketscan 商业数据库和 Optum 的去识别 Clinformatics 数据集市数据库，使用临床专家开发的算法，确定接受利福昔明或乳果糖单药治疗的商业保险 HE 患者。根据使用诊断代码和诊断相关组代码的算法，确定与 HE 相关的住院治疗。使用发病率比率和调整后的成本差异，比较利福昔明和乳果糖治疗期之间的与 HE 相关的/全因住院入院/天数和医疗保健成本。
在 Marketscan 中，纳入了 13515 例[Optum：5217]利福昔明治疗期和 9946 例[4897]乳果糖单药治疗期。与乳果糖单药治疗相比，利福昔明治疗的患者每年与 HE 相关的住院治疗入院率降低了 33%[34%]，与 HE 相关的住院天数也相应降低了 43%[57%]。每年全因住院入院率降低了 27%[27%]；全因住院天数降低了 33%[37%]。利福昔明治疗期患者的每月每位患者的总平均医疗费用和与 HE 相关的住院费用分别降低了 2417 美元[2301 美元]和 173 美元[397 美元]（ < .05）。尽管与利福昔明相关的药物成本增加，但总体医疗保健成本没有变化。与非依从性患者相比，依从性利福昔明的患者总医疗保健成本降低了 2891 美元[2340 美元]。在模拟的 100 万例患者中，如果 50%的乳果糖单药治疗的 HE 患者添加利福昔明并对利福昔明治疗依从，每年的总成本节省将达到 750 万美元[610 万美元]（每年每位患者 0.62 美元[0.50 美元]）。
与乳果糖单药治疗相比，利福昔明治疗的患者与 HE 相关的和全因住院治疗的发生率显著降低，导致设施和专业费用降低。如果提高 HE 患者对利福昔明的依从性，可能会节省成本。
本研究受到索赔分析中常见的局限性的限制。
