Department of Health Sciences, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands.
Asc Academics, Groningen, The Netherlands.
J Med Econ. 2021 Jan-Dec;24(1):1149-1163. doi: 10.1080/13696998.2021.1983291.
Rifaximin-α as an adjunct to lactulose is reimbursed in the Netherlands for prevention of the third and subsequent episodes of overt Hepatic Encephalopathy (HE) in cirrhotic patients. However, use of rifaximin-α remains limited. This study evaluates the clinical and economic impact of treating all patients eligible under Dutch reimbursement conditions with rifaximin-α as an adjunct to lactulose for the prevention of overt HE in the Netherlands from a hospital and healthcare payer's perspective.
A budget impact analysis was performed following national and international guidelines. Resource use was based on Dutch real-world data. HE-related cost inputs were based on the declaration codes, Dutch cost manual, and actual drug list prices. Several sensitivity and scenario analyses were conducted to assess model robustness.
Treating eligible HE patients with rifaximin-α in addition to lactulose saves €4,487 and costs €249 per patient over a 5-year period compared with lactulose monotherapy from hospital and healthcare payer's perspectives, respectively. In the Netherlands, an estimated 38% of the 2,567 eligible patients are currently being treated with rifaximin-α. Optimizing rifaximin-α use by treating all eligible patients with the rifaximin-α + lactulose could save more than 3,000 hospital admissions, almost 15,000 hospital bed days, and 300 deaths over a 5-year period. Despite increased drug costs, treatment is estimated to result in potential cost savings over a 5-year period of 7.2 million euros from a Dutch hospital perspective. The budget impact is 397,770 euros from a healthcare payer's perspective.
Next to a clinical perspective, also from an economic perspective, wider prescription of rifaximin-α adhering to guidelines could be beneficial to reduce costs from a hospital perspective. From a healthcare payer's perspective, costs increase with addition of rifaximin-α due to relative better survival causing relatively higher drug and liver transplantation-related costs.
利福昔明-α 联合乳果糖用于预防肝硬化患者第三次及以后显性肝性脑病（HE）发作，在荷兰可获得报销。然而，利福昔明-α 的使用仍然受到限制。本研究从医院和医疗保健支付者的角度，评估根据荷兰报销条件，对所有符合条件的患者使用利福昔明-α 联合乳果糖治疗显性 HE，对荷兰的临床和经济影响。
根据国家和国际指南进行预算影响分析。资源使用基于荷兰真实世界数据。HE 相关成本输入基于申报代码、荷兰成本手册和实际药物清单价格。进行了几种敏感性和情景分析，以评估模型的稳健性。
从医院和医疗保健支付者的角度来看，与乳果糖单药治疗相比，在 5 年内，用利福昔明-α 联合乳果糖治疗符合条件的 HE 患者可节省 4487 欧元，并使每位患者的成本降低 249 欧元。在荷兰，估计目前有 2567 名符合条件的患者中有 38%正在用利福昔明-α 治疗。通过用利福昔明-α+乳果糖治疗所有符合条件的患者，优化利福昔明-α 的使用，在 5 年内可节省 3000 多次住院治疗、近 15000 个住院床位日和 300 例死亡。尽管药物成本增加，但从荷兰医院的角度来看，在 5 年内治疗估计可节省 720 万欧元的潜在成本。从医疗保健支付者的角度来看，预算影响为 397770 欧元。
除了临床观点外，从经济角度来看，更广泛地遵循指南处方利福昔明-α，也可能有助于降低医院的成本。从医疗保健支付者的角度来看，由于相对较高的生存，添加利福昔明-α 会导致相对较高的药物和肝移植相关成本，成本会增加。
