Jesudian Arun B, Gagnon-Sanschagrin Patrick, Heimanson Zeev, Bungay Rebecca, Chen Jingyi, Guérin Annie, Bumpass Brock, Borroto Danellys, Joseph George, Dashputre Ankur A
Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY, USA.
Analysis Group, Inc, Montréal, Canada.
J Med Econ. 2023 Jan-Dec;26(1):1169-1177. doi: 10.1080/13696998.2023.2255074. Epub 2023 Sep 4.
To assess the impact of rifaximin (± lactulose) use following discharge of an initial overt hepatic encephalopathy (OHE) hospitalization on OHE rehospitalizations and healthcare costs in a real-world setting.
Adults (18-64 years) with an OHE hospitalization were identified from MarketScan® Commercial claims (Q4'15-Q2'20), classified into two mutually exclusive treatment cohorts (i.e. rifaximin and no rifaximin treatment), and further stratified into four subgroups based on decreasing quality of care (QoC; i.e. Type 1 - rifaximin without delay post-discharge; Type 2 - rifaximin with delay post-discharge; Type 3 - lactulose only post-discharge; Type 4 - no rifaximin/lactulose treatment post-discharge). The impact of rifaximin use on 30-day and annualized OHE hospitalizations and healthcare costs were assessed between cohorts and by the QoC subgroup.
Characteristics were similar between the rifaximin ( = 1,452; Type 1: 1,138, Type 2: 314) and no rifaximin ( = 560; Type 3:337, Type 4: 223) treatment cohorts. The 30-day risk of OHE rehospitalization was lower for the rifaximin vs. no rifaximin treatment cohort (odds ratio 0.56, < .01) and increased with decreasing QoC. The annual rate of OHE hospitalizations was 59% lower for the rifaximin treatment cohort (incidence rate ratio 0.41, < .01) and increased with decreasing QoC. Compared to the no rifaximin treatment cohort, the rifaximin treatment cohort had higher pharmacy costs, lower medical costs, and no difference in total healthcare costs.
This was a claims-based study subject to common data limitations such as billing inaccuracies or omissions in coded claims. Total healthcare costs were reported from a payer's perspective, which do not capture indirect costs associated with patient burden.
Initiation of rifaximin after an OHE hospitalization was associated with reduced OHE hospitalizations both in the 30-days following and annually. Further, reduced medical costs offset increased pharmacy costs, and no annual cost differences were observed between cohorts.
评估在现实环境中，初始显性肝性脑病（OHE）住院出院后使用利福昔明（±乳果糖）对OHE再住院率和医疗费用的影响。
从MarketScan®商业索赔数据（2015年第四季度至2020年第二季度）中识别出因OHE住院的成年人（18 - 64岁），分为两个相互排斥的治疗队列（即利福昔明治疗组和非利福昔明治疗组），并根据护理质量（QoC）下降情况进一步分为四个亚组（即1型 - 出院后立即使用利福昔明；2型 - 出院后延迟使用利福昔明；3型 - 出院后仅使用乳果糖；4型 - 出院后不使用利福昔明/乳果糖）。评估利福昔明使用对30天和年度OHE住院率及医疗费用的影响，比较不同队列以及按QoC亚组进行分析。
利福昔明治疗组（n = 1452；1型：1138，2型：314）和非利福昔明治疗组（n = 560；3型：337，4型：223）的特征相似。与非利福昔明治疗组相比，利福昔明治疗组30天OHE再住院风险较低（比值比0.56，P <.01），且随着QoC降低而增加。利福昔明治疗组的年度OHE住院率低59%（发病率比0.41，P <.01），且随着QoC降低而增加。与非利福昔明治疗组相比，利福昔明治疗组的药品成本较高，医疗成本较低，总医疗费用无差异。
这是一项基于索赔数据的研究，存在常见的数据局限性，如计费不准确或编码索赔中的遗漏。总医疗费用是从支付方的角度报告的，未涵盖与患者负担相关的间接成本。
OHE住院后开始使用利福昔明与30天内及年度的OHE住院率降低相关。此外，医疗成本的降低抵消了药品成本的增加，各队列之间未观察到年度成本差异。
