Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA.
Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota, College of Pharmacy, Minneapolis, Minnesota, USA.
Hepatol Commun. 2023 Aug 3;7(8). doi: 10.1097/HC9.0000000000000215. eCollection 2023 Aug 1.
Hepatic encephalopathy (HE) is associated with significant morbidity and mortality for those with cirrhosis. Despite the known benefits of rifaximin use for HE, treatment retention remains low. This study aimed to evaluate the impact of out-of-pocket (OOP) rifaximin cost on treatment retention among commercially insured patients in the United States.
Adult patients with cirrhosis and HE were identified from the IBM MarketScan claims database. Those who began rifaximin treatment between January 1, 2011, and December 1, 2021 were included. Regression models were used to analyze the relationship between patients' 30-day OOP rifaximin cost and rifaximin retention (≥80% eligible days with rifaximin supply) at 180, 360, and 540 days. Models were controlled for patient demographic and clinical characteristics including age, sex, comorbid conditions, Charlson comorbidity index (CCI), and lactulose use.
A total of 6839 adult patients were included. Most patients were between 55 and 64 years (57.1%), male (60.4%), and living in urban settings (84.6%). Treatment retention was low for all time periods; retention rates for rifaximin were 42%, 25%, and 16% at 180, 360, and 540 days, respectively. In multivariable analysis, 30-day OOP costs of ≥ $150 were associated with a decreased likelihood of rifaximin retention at 180, 360, and 540 days [relative risk (RR) = 0.67, RR = 0.62, and R = 0.60, respectively]. Younger age was associated with reduced treatment retention for all time periods. Metastatic cancer and depression were associated with reduced treatment retention at 180 days (RR = 0.70 and RR = 0.87, respectively).
Rates of rifaximin treatment retention are low despite the known benefits of rifaximin use for breakthrough HE. High 30-day OOP cost is associated with reduced rifaximin treatment retention.
肝性脑病（HE）会导致肝硬化患者出现较高的发病率和死亡率。尽管利福昔明在治疗 HE 方面具有显著的益处，但患者的治疗保留率仍然较低。本研究旨在评估美国商业保险患者中，自付（OOP）利福昔明费用对治疗保留率的影响。
从 IBM MarketScan 索赔数据库中确定患有肝硬化和 HE 的成年患者。纳入自 2011 年 1 月 1 日至 2021 年 12 月 1 日开始利福昔明治疗的患者。使用回归模型分析患者 30 天 OOP 利福昔明费用与 180、360 和 540 天时利福昔明保留率（有资格使用利福昔明的天数≥80%）之间的关系。模型控制了患者的人口统计学和临床特征，包括年龄、性别、合并症、Charlson 合并症指数（CCI）和乳果糖的使用。
共纳入 6839 名成年患者。大多数患者年龄在 55 至 64 岁之间（57.1%），男性（60.4%），居住在城市地区（84.6%）。所有时间段的治疗保留率均较低；利福昔明的保留率分别为 180 天 42%、360 天 25%和 540 天 16%。多变量分析显示，30 天 OOP 费用≥$150 与 180、360 和 540 天时利福昔明保留率降低相关[相对风险（RR）=0.67、RR=0.62 和 RR=0.60]。年龄较小与所有时间段的治疗保留率降低相关。转移性癌症和抑郁症与 180 天时的治疗保留率降低相关（RR=0.70 和 RR=0.87）。
尽管利福昔明在治疗突破性 HE 方面具有显著的益处，但利福昔明治疗的保留率仍然较低。高 30 天 OOP 费用与利福昔明治疗保留率降低相关。
