Economic impact of the use of rifaximin 550 mg twice daily for the treatment of overt hepatic encephalopathy in Italy

Abstract

Purpose

Hepatic encephalopathy (HE) is associated with a reduced survival, an increased risk of hospitalization for recurrences, and a reduced health-related quality of life. The purpose of the present economic analysis was to evaluate the impact on the Italian National Health Service (INHS) expenditure of the treatment with rifaximin 550 mg twice daily (Tixteller^®/Tixtar^®) for the reduction of the recurrences of overt HE, with respect to the current treatment approach.

Patients and methods

Costs associated with patients treated with rifaximin 550 mg twice daily were estimated considering the reduction in hospitalizations for HE recurrences revealed by registrative clinical trial (−50%) applied to the hospitalization rate (42.5%) emerging from an Italian observational real-world study; costs associated with patients not treated with rifaximin were estimated based on the hospitalization rate, resulting from the same Italian observational study. Sensitivity analyses considering possible different discount levels to INHS structures for rifaximin were performed. The INHS perspective for a period of 3 years was considered.

Results

The treatment with rifaximin 550 mg twice daily, although increasing drug costs, is associated with a reduction in hospitalizations for HE recurrences that leads to an overall reduction of total costs charged to INHS, which could be estimated, based on the forecasted uptake of the treatment, at about €130,000 in the first year, reaching ~€260,000 in the third year. Considering a possible discount for rifaximin 550 mg to INHS structure of 20%, the total saving at the third year accounts for ~€3,000,000. Moreover, a relevant reduction in the number of hospitalizations and bed days is associated with rifaximin treatment.

Conclusion

The treatment with rifaximin 550 mg twice daily, even if associated with an increase in drug expenditure, results in a reduction in total health care costs charged to INHS due to a reduction in hospitalizations for HE recurrences.

Keywords:

• overt hepatic encephalopathy recurrences
• health care expenditure
• costs
• hospitalizations
• budget impact

Acknowledgments

The authors are grateful to Maria Elena Calicchia and David Dickens for the English language editing. This economic evaluation was supported by an unrestricted grant from Alfa Wassermann.

Author contributions

Both the authors devised and performed the analysis, wrote the paper, contributed to drafting and revising the paper, and agreed to be accountable for all aspects of the work.

Disclosure

AR and DPR are consultants of Alfa Wassermann. The authors report no other conflicts of interest in this work.