ABSTRACT
Complications of chronic liver disease, such as hepatic encephalopathy (HE), can have
a substantial impact on the economic burden of liver disease. In the United States,
a report of 162,734 inpatient hospital discharges included HE or unspecified encephalopathy
diagnoses in 2004, a 234% increase over data from 1993. Hospital charges for HE and
HE-related conditions also increased from 1993 to 2004 in the United States. Mean
hospital charges have increased despite a steady reduction in the mean duration of
stay, a trend that may reflect advances in treatment. Several studies have provided
data about the cost-effectiveness of rifaximin and lactulose as treatments for HE.
These studies showed that, although rifaximin costs more per tablet than lactulose,
rifaximin is more cost-effective for long-term therapy. Further studies are warranted
to more fully evaluate the relative long-term cost-effectiveness of specific HE treatments.
KEYWORDS
Hepatic encephalopathy - health care utilization - lactulose - rifaximin
REFERENCES
- 1 American Gastroenterological Association .The Burden of Gastrointestinal Diseases.
Chapter 5: Hepatobiliary and pancreatic disorders. http://Available at: www.gastro.org/user-assets/Documents/burden-report.pdf Accessed January 5, 2007
- 2
Mas A.
Hepatic encephalopathy: from pathophysiology to treatment.
Digestion.
2006;
73(suppl 1)
86-93
- 3
Abou-Assi S, Vlahcevic Z R.
Hepatic encephalopathy: metabolic consequence of cirrhosis often is reversible.
Postgrad Med.
2001;
109
52-60, 63
- 4
Amodio P, Del Piccolo F, Petteno E et al..
Prevalence and prognostic value of quantified electroencephalogram (EEG) alterations
in cirrhotic patients.
J Hepatol.
2001;
35
37-45
- 5
Romero-Gomez M, Boza F, Garcia-Valdecasas M S et al..
Subclinical hepatic encephalopathy predicts the development of overt hepatic encephalopathy.
Am J Gastroenterol.
2001;
96
2718-2723
- 6
Ytting H, Moller S, Henriksen J H et al..
Prognosis in patients with cirrhosis and mild portal hypertension.
Scand J Gastroenterol.
2006;
41
1446-1453
- 7
Hartmann I J, Groeneweg M, Quero J C et al..
The prognostic significance of subclinical hepatic encephalopathy.
Am J Gastroenterol.
2000;
95
2029-2034
- 8
Kircheis G, Wettstein M, Timmermann L et al..
Critical flicker frequency for quantification of low-grade hepatic encephalopathy.
Hepatology.
2002;
35
357-366
- 9
Groeneweg M, Quero J C, De Bruijn I et al..
Subclinical hepatic encephalopathy impairs daily functioning.
Hepatology.
1998;
28
45-49
- 10
Das A, Dhiman R K, Saraswat V A et al..
Prevalence and natural history of subclinical hepatic encephalopathy in cirrhosis.
J Gastroenterol Hepatol.
2001;
16
531-535
- 11
Han M K, Hyzy R.
Advances in critical care management of hepatic failure and insufficiency.
Crit Care Med.
2006;
34
S225-S231
- 12 Agency for Healthcare Research Quality .HCUPnet: Healthcare Cost and Utilization
Project. Available at: http://hcupnet.ahrq.gov/HCUPnet.jsp?Id=DBE1CCF502E0C25D&Form=SelQUERYTYPE&JS=Y&Action=%3E%3ENext%3E%3E&_QUERYTYPE=Trends Accessed February 2007
- 13
Shaheen N J, Hansen R A, Morgan D R et al..
The burden of gastrointestinal and liver diseases, 2006.
Am J Gastroenterol.
2006;
101
2128-2138
- 14
Wong J B, McQuillan G M, McHutchison J G, Poynard T.
Estimating future hepatitis C morbidity, mortality, and costs in the United States.
Am J Public Health.
2000;
90
1562-1569
- 15
Koo H L, DuPont H L.
Current and future developments in travelers' diarrhea therapy.
Expert Rev Anti Infect Ther.
2006;
4
417-427
- 16
Scarpignato C, Pelosini I.
Experimental and clinical pharmacology of rifaximin, a gastrointestinal selective
antibiotic.
Digestion.
2006;
73(suppl 1)
13-27
- 17
Neff G W, Kemmer N, Zacharias V C et al..
Analysis of hospitalizations comparing rifaximin versus lactulose in the management
of hepatic encephalopathy.
Transplant Proc.
2006;
38
3552-3555
- 18
Spiegel B, Huang E, Esrailian E.
Is rifaximin cost-effective in the management of hepatic encephalopathy?.
Gastroenterology.
2006;
130
A-806
- 19
Leevy C B, Phillips J A.
Hospitalizations during the use of rifaximin versus lactulose for the treatment of
hepatic encephalopathy.
Dig Dis Sci.
2007;
52
737-741
Carroll B LeevyM.D.
New Jersey Medical School Liver Center
90 Bergen Street, Suite 2100, Newark, NJ 07103