Diederick J van Doorn, Kirsi M A van Eekhout, Koos de Wit, L C Baak, Michael Klemt-Kropp, Bart J Verwer, Philip Friederich, Gijs J de Bruin, Xander G Vos, Joost P H Drenth, R Bart Takkenberg
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引用次数: 0
Abstract
Background and aims: Hepatic encephalopathy is a frequent complication of cirrhosis. Rifaximin-α has been included in guidelines for secondary prevention of hepatic encephalopathy, but there are few real-world data on its efficacy and impact on healthcare utilization. In this study, we aimed to assess the effect of rifaximin-α on healthcare utilization.
Method: We conducted a cohort analysis in patients from seven hospitals in the Netherlands, who received rifaximin-α as secondary prophylaxis for hepatic encephalopathy. Data were compared 6 months before and 6 months after the prescription of rifaximin-α. The primary endpoint was the effect of rifaximin-α on healthcare utilization. Secondary endpoint was the effect of rifaximin-α on healthcare costs.
Results: We included 126 patients (65% male; median age 68) with a median Model for End-stage Liver Disease score of 15. The mean number of hepatic encephalopathy episodes after starting rifaximin-α was lower than before starting rifaximin-α (0.9 vs. 2.2; p < 0.001). Mean healthcare utilization decreased from 6.1 contacts in the 6 months before rifaximin-α to 3.3 contacts in the 6 months after starting rifaximin-α (p < 0.001). The mean number of hospital admissions decreased from 1.7 admissions per patient to 1.0 admissions after starting rifaximin-α (p < 0.001). The mean number of outpatient visits also decreased after starting rifaximin-α (2.4 visits per patient to 1.7; p = 0.001). Annual costs per patient before starting rifaximin-α were €13,320. This was similar to the costs after rifaximin-α was prescribed (€13,120).
Conclusion: Rifaximin-α significantly reduced the number of episodes of hepatic encephalopathy, the number of hospital admissions as well as the number of outpatient and emergency department visits, contributing to a reduction in healthcare utilization. There was no reduction in overall costs.
背景和目的:肝性脑病是肝硬化的常见并发症。利福昔明-α已被纳入肝性脑病二级预防指南,但关于其疗效和对医疗保健利用的影响的实际数据很少。在本研究中,我们旨在评估利福昔明-α对医疗保健利用的影响。方法:我们对荷兰7家医院接受利福昔明-α作为肝性脑病二级预防治疗的患者进行了队列分析。比较处方利福昔明-α前后6个月的数据。主要终点是利福昔明-α对医疗保健利用的影响。次要终点是利福昔明-α对医疗费用的影响。结果:我们纳入126例患者(65%男性;中位年龄68岁),终末期肝病模型中位评分为15分。开始使用利福昔明-α后肝性脑病发作的平均次数低于开始使用利福昔明-α前(0.9 vs 2.2;结论:利福昔明-α显著降低肝性脑病发作次数、住院次数和门急诊次数,有助于降低医疗保健利用率。总体成本没有减少。
期刊介绍:
United European Gastroenterology Journal (UEG Journal) is the official Journal of the United European Gastroenterology (UEG), a professional non-profit organisation combining all the leading European societies concerned with digestive disease. UEG’s member societies represent over 22,000 specialists working across medicine, surgery, paediatrics, GI oncology and endoscopy, which makes UEG a unique platform for collaboration and the exchange of knowledge.