Impact of Post-Discharge Rifaximin Use Following an Overt Hepatic Encephalopathy (OHE) Hospitalization on Annual Rates of OHE Rehospitalization in the United States
Author(s)
Arun B Jesudian, MD1, Patrick Gagnon-Sanschagrin, MSc2, Rebecca Bungay, MSc2, Kaitlyn Easson, PhD2, Kana Yokoji, MSc2, Annie Guerin, MSc2, Aaron Samson, PharmD3, Shweta Kiran Shah, PhD3, Olamide Olujohungbe, PharmD3.
1Weill Cornell Medicine, New York, NY, USA, 2Analysis Group, Inc., Montréal, QC, Canada, 3Bausch Health, Bridgewater, NJ, USA.
1Weill Cornell Medicine, New York, NY, USA, 2Analysis Group, Inc., Montréal, QC, Canada, 3Bausch Health, Bridgewater, NJ, USA.
OBJECTIVES: Practice guidelines support rifaximin as an add-on to lactulose following breakthrough OHE for improved quality of care (QoC). We assessed the impact of post-OHE-hospitalization-discharge use of rifaximin on OHE rehospitalization rates, accounting for pre-index OHE medication use.
METHODS: Commercially-insured patients with an initial OHE hospitalization (index event) were identified from Komodo Research Data (01/2016 - 09/2023). OHE medication use during the six months before index event and 30 days post-discharge were assessed. OHE rehospitalizations were measured post-discharge until the earliest of end of continuous health plan enrollment or data availability, liver transplant, or rifaximin discontinuation (among rifaximin-treated patients) or initiation (among lactulose-only-treated patients). Annual OHE rehospitalization rates were compared between patients receiving rifaximin (± lactulose) versus lactulose only post-discharge, stratified by pre-index OHE medication use (rifaximin ± lactulose, lactulose only, or no treatment), and across QoC stratifications: high (rifaximin post-discharge, any pre-index treatment), intermediate (lactulose only post-discharge, no pre-index treatment), and low (lactulose only post-discharge, rifaximin pre-index). Analyses were replicated for Medicare and Medicaid patients.
RESULTS: Of 7,880 commercially-insured patients included (mean age: 54.9 years, 39.9% female), patients receiving lactulose only post-discharge had significantly higher incidence of OHE rehospitalization compared to those receiving rifaximin, regardless of pre-index OHE medication use (incidence rate ratio range across pre-index treatment stratifications: 1.74 - 2.59, all p<0.05). Rehospitalization rates increased as QoC decreased; compared to patients with high QoC, those with intermediate QoC had 1.53 times higher annual OHE rehospitalization rates, and those with low QoC had 2.44 times higher rates (all p<0.05). Similar trends were observed among Medicare (N=4,131) and Medicaid (N=2,924) patients.
CONCLUSIONS: Rifaximin use post-OHE-hospitalization-discharge was associated with a significant reduction in OHE rehospitalization rates, regardless of pre-index OHE medication use. These findings highlight the importance of timely rifaximin access post-discharge.
METHODS: Commercially-insured patients with an initial OHE hospitalization (index event) were identified from Komodo Research Data (01/2016 - 09/2023). OHE medication use during the six months before index event and 30 days post-discharge were assessed. OHE rehospitalizations were measured post-discharge until the earliest of end of continuous health plan enrollment or data availability, liver transplant, or rifaximin discontinuation (among rifaximin-treated patients) or initiation (among lactulose-only-treated patients). Annual OHE rehospitalization rates were compared between patients receiving rifaximin (± lactulose) versus lactulose only post-discharge, stratified by pre-index OHE medication use (rifaximin ± lactulose, lactulose only, or no treatment), and across QoC stratifications: high (rifaximin post-discharge, any pre-index treatment), intermediate (lactulose only post-discharge, no pre-index treatment), and low (lactulose only post-discharge, rifaximin pre-index). Analyses were replicated for Medicare and Medicaid patients.
RESULTS: Of 7,880 commercially-insured patients included (mean age: 54.9 years, 39.9% female), patients receiving lactulose only post-discharge had significantly higher incidence of OHE rehospitalization compared to those receiving rifaximin, regardless of pre-index OHE medication use (incidence rate ratio range across pre-index treatment stratifications: 1.74 - 2.59, all p<0.05). Rehospitalization rates increased as QoC decreased; compared to patients with high QoC, those with intermediate QoC had 1.53 times higher annual OHE rehospitalization rates, and those with low QoC had 2.44 times higher rates (all p<0.05). Similar trends were observed among Medicare (N=4,131) and Medicaid (N=2,924) patients.
CONCLUSIONS: Rifaximin use post-OHE-hospitalization-discharge was associated with a significant reduction in OHE rehospitalization rates, regardless of pre-index OHE medication use. These findings highlight the importance of timely rifaximin access post-discharge.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE220
Topic
Economic Evaluation
Disease
SDC: Gastrointestinal Disorders, SDC: Neurological Disorders