Analysis of Hospitalizations Comparing Rifaximin Versus Lactulose in the Management of Hepatic Encephalopathy

• Published in: Transplantation proceedings 2006-12, Vol.38 (10), p.3552-3555
• Main Authors: Neff, G.W., Kemmer, N., Zacharias, V.C., Kaiser, T., Duncan, C., McHenry, R., Jonas, M., Novick, D., Williamson, C., Hess, K., Thomas, M., Buell, J.
• Format: Article
• Language: English
• Subjects: Adult; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Biological and medical sciences; Costs and Cost Analysis; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Gastrointestinal Agents - therapeutic use; Hepatic Encephalopathy - drug therapy; Hospitalization - economics; Hospitalization - statistics & numerical data; Humans; Lactulose - therapeutic use; Length of Stay; Liver Failure - complications; Liver Failure - drug therapy; Liver Transplantation; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Pilot Projects; Postoperative Complications - drug therapy; Retrospective Studies; Rifamycins - therapeutic use; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue, organ and graft immunology
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2006.10.107

Patients with end-stage liver disease often develop hepatic encephalopathy. The loss in cognitive abilities results in marked economic loss to the patient and health care community. We report hospital admission rates and economic impact of patients with end-stage liver disease suffering from hepatic encephalopathy. The medical records were reviewed involving liver transplant patients started on lactulose or rifaximin therapy after presenting with stage 2 hepatic encephalopathy from January 2004 to November 2005. Information collected included demographics, hospitalizations required for hepatic encephalopathy, economic data, and Model for End-stage Liver Disease (MELD) score. Thirty-nine patients met study criteria: 24 patients treated with lactulose (group one) and 15 with rifaximin (group two). Group one included 18 men and six women of mean age 48 (range 39 to 58), average MELD 14 (range 10 to 19). Group two included 10 men and five women of mean age 47 (range 42 to 58), average MELD 15 (range 10 to 19). Group one patients required 19 hospitalizations overall: three patients with three hospitalizations, four patients with two hospitalizations, and two patients required one hospitalization. Total drug cost per month was $50 (group one) and $620 (group two). The average annual cost of hospitalization, emergency room visit, and drug per patient treated was $13,284.96 for a total of $318,839 (range $5005 to $26,255, including drug cost and hospital care). Group two required three hospitalizations, all three with one visit. The average annual cost of hospitalization, emergency room visit, and drug per patient treated was $7958.13 for a total of $119,372 (range $6005 to $19,255, including drug cost and hospital care). The total cost of therapy per patient per year was $13,285 (group one) versus $7958 (group two). The average length of stay was shorter in group two [3.5 days (range 3 to 4)] versus group 1 [5.0 days (range 3 to 10); P < .0001]. These pilot data demonstrate the marked difference in economic costs for the treatment of hepatic encephalopathy. The results also show that in comparative groups, the economic gains are quickly lost when using lactulose.