TY - JOUR
T1 - THE IMPACT ON HOSPITAL RESOURCE UTILISATION OF RIFAXIMIN-ALPHA FOR HEPATIC ENCEPHALOPATHY IN ROUTINE CLINICAL PRACTICE: REAL WORLD DATA FROM SEVEN UK LIVER CENTRES
AU - Orr, James G.
AU - Goel, A
AU - Moriarty, K
AU - Sinha, A
AU - Gordon, F.H.
AU - Dethier, A
AU - Dillon, J
AU - Patel, Vishal C.
AU - Shawcross, Debbie
AU - Clark, K
AU - Richardson, P
AU - Preedy, H
AU - Aspinall, R
AU - Currie, C.J.
AU - Hudson, M
PY - 2015
Y1 - 2015
N2 - Background and Aims: Rifaximin-a (RFX) has been shown to reduce recurrence of overt hepatic encephalopathy (HE) in patients with cirrhosis. However, there is concern over the cost-effectiveness of the drug with average annual treatment with RFX costing £3,379 (€4,228). Early observational data suggested that treatment might reduce hospital admissions and decrease hospital length of stay (HLOS). The aim of this study was to determine the impact of treatment with RFX on hospital resource utilisation, using data from multiple liver centres from across the UK.
Methods: All seven participating centres agreed a standardised data collection pro-forma. Details of hospital admissions were requested at three, six and 12 months prior to RFX exposure, and for the same periods during RFX treatment. Where data were unavailable for any particular patient, data were annualised from the observation(s) provided. Clinical data were recorded at baseline, at three months, and at the end of the study period. Inpatient costs were estimated in UK£ (€@1.2×£) at 2008/9 prices from published National Health Service sources: mean £487 (€580) per day for admissions for liver disease.
Results: Data were available from 295 patients, 30% female, mean age 58 (SD 12) years, aetiologies: ARLD 60%, NAFLD 14%, viral 10%. 92% were taking concurrent lactulose. Mean baseline MELD score was 15.3 (SD 6.2). Mortality at 30 days, 90 days and 1 year were 5%, 10% and 21%, respectively, with significantly higher MELD scores at each time point (all p < 0.001). The mean number of hospital admissions decreased from 2.9 admissions per person per year before RFX to 1.7 during treatment (D 41%, p < 0.001). The mean hospital length of stay per admission decreased from 11.0 days before to 9.5 days during RFX treatment (D 13%, p < 0.001). This resulted in a reduction in mean annual bed occupancy from 31.7 days before to 16.4 days during RFX treatment (D 48%, p < 0.001), representing an annual reduction in inpatient liver care costs of £7,463 (€8,956) per patient. There was no change from baseline MELD at 3 months and 1 year (D −0.4 and −0.2 respectively). In addition, there was no clear correlation between MELD score and admissions.
Conclusions: RFX was associated with a marked reduction in the number of admissions and hospital length of stay, factors that should be taken into account when determining cost effectiveness. The likelihood of admission was independent of MELD score and the response to RFX may not be solely determined by disease severity.
AB - Background and Aims: Rifaximin-a (RFX) has been shown to reduce recurrence of overt hepatic encephalopathy (HE) in patients with cirrhosis. However, there is concern over the cost-effectiveness of the drug with average annual treatment with RFX costing £3,379 (€4,228). Early observational data suggested that treatment might reduce hospital admissions and decrease hospital length of stay (HLOS). The aim of this study was to determine the impact of treatment with RFX on hospital resource utilisation, using data from multiple liver centres from across the UK.
Methods: All seven participating centres agreed a standardised data collection pro-forma. Details of hospital admissions were requested at three, six and 12 months prior to RFX exposure, and for the same periods during RFX treatment. Where data were unavailable for any particular patient, data were annualised from the observation(s) provided. Clinical data were recorded at baseline, at three months, and at the end of the study period. Inpatient costs were estimated in UK£ (€@1.2×£) at 2008/9 prices from published National Health Service sources: mean £487 (€580) per day for admissions for liver disease.
Results: Data were available from 295 patients, 30% female, mean age 58 (SD 12) years, aetiologies: ARLD 60%, NAFLD 14%, viral 10%. 92% were taking concurrent lactulose. Mean baseline MELD score was 15.3 (SD 6.2). Mortality at 30 days, 90 days and 1 year were 5%, 10% and 21%, respectively, with significantly higher MELD scores at each time point (all p < 0.001). The mean number of hospital admissions decreased from 2.9 admissions per person per year before RFX to 1.7 during treatment (D 41%, p < 0.001). The mean hospital length of stay per admission decreased from 11.0 days before to 9.5 days during RFX treatment (D 13%, p < 0.001). This resulted in a reduction in mean annual bed occupancy from 31.7 days before to 16.4 days during RFX treatment (D 48%, p < 0.001), representing an annual reduction in inpatient liver care costs of £7,463 (€8,956) per patient. There was no change from baseline MELD at 3 months and 1 year (D −0.4 and −0.2 respectively). In addition, there was no clear correlation between MELD score and admissions.
Conclusions: RFX was associated with a marked reduction in the number of admissions and hospital length of stay, factors that should be taken into account when determining cost effectiveness. The likelihood of admission was independent of MELD score and the response to RFX may not be solely determined by disease severity.
U2 - 10.1016/S0168-8278(15)30387-1
DO - 10.1016/S0168-8278(15)30387-1
M3 - Meeting abstract
SN - 0168-8278
VL - 62
SP - S366
JO - Journal of Hepatology
JF - Journal of Hepatology
IS - Supplement 2
M1 - P0168
T2 - 50th The International Liver Congress - European Association for the Study of the Liver
Y2 - 22 April 2015 through 26 April 2015
ER -