Budget impact of optimizing rifaximin-α use for the prevention of recurrent hepatic encephalopathy in The Netherlands

Rifaximin-α as an adjunct to lactulose is reimbursed in the Netherlands for prevention of the third and subsequent episodes of overt Hepatic Encephalopathy (HE) in cirrhotic patients. However, use of rifaximin-α remains limited. This study evaluates the clinical and economic impact of treating all patients eligible under Dutch reimbursement conditions with rifaximin-α as an adjunct to lactulose for the prevention of overt HE in the Netherlands from a hospital and healthcare payer’s perspective. A budget impact analysis was performed following national and international guidelines. Resource use was based on Dutch real-world data. HE-related cost inputs were based on the declaration codes, Dutch cost manual, and actual drug list prices. Several sensitivity and scenario analyses were conducted to assess model robustness. Treating eligible HE patients with rifaximin-α in addition to lactulose saves €4,487 and costs €249 per patient over a 5-year period compared with lactulose monotherapy from hospital and healthcare payer’s perspectives, respectively. In the Netherlands, an estimated 38% of the 2,567 eligible patients are currently being treated with rifaximin-α. Optimizing rifaximin-α use by treating all eligible patients with the rifaximin-α + lactulose could save more than 3,000 hospital admissions, almost 15,000 hospital bed days, and 300 deaths over a 5-year period. Despite increased drug costs, treatment is estimated to result in potential cost savings over a 5-year period of 7.2 million euros from a Dutch hospital perspective. The budget impact is 397,770 euros from a healthcare payer’s perspective. Next to a clinical perspective, also from an economic perspective, wider prescription of rifaximin-α adhering to guidelines could be beneficial to reduce costs from a hospital perspective. From a healthcare payer’s perspective, costs increase with addition of rifaximin-α due to relative better survival causing relatively higher drug and liver transplantation-related costs.

Rifaximin-α作为乳果糖的辅助药物，在荷兰被批准用于预防肝硬化患者第三及以后发生的显性肝性脑病（HE）的发作。然而，rifaximin-α的使用仍受到限制。本研究从医院和医疗支付方的视角，评估了在荷兰对所有符合荷兰报销条件且接受rifaximin-α联合乳果糖治疗以预防显性HE的合格患者进行治疗，其临床及经济影响。研究遵循国家及国际指南进行了预算影响分析。资源使用基于荷兰真实世界数据。基于医院和医疗支付方的视角，与乳果糖单药治疗相比，对符合条件的HE患者使用rifaximin-α联合乳果糖治疗，在5年期间每例患者可节省4,487欧元，并增加249欧元的费用。在荷兰，目前约有38%的2,567名符合条件的患者正在接受rifaximin-α治疗。通过为所有符合条件的患者提供rifaximin-α联合乳果糖治疗，优化rifaximin-α的使用，在5年期间预计可节省超过3,000次住院，几乎15,000个住院床位日，以及300例死亡。尽管药物成本增加，但从荷兰医院的角度来看，预计在5年内治疗可能实现高达720万欧元的潜在成本节约。从医疗支付方的视角来看，预算影响为397,770欧元。除了临床视角之外，从经济角度出发，根据指南更广泛地开具rifaximin-α处方也可能有助于从医院视角降低成本。从医疗支付方的视角来看，由于相对更好的生存率导致药物和肝移植相关的成本相对较高，因此随着rifaximin-α的添加，成本也会相应增加。