Abstract | BACKGROUND: METHODS: RESULTS: Under base-case conditions, 'do nothing' was least effective and rifaximin salvage was most effective. Lactulose monotherapy was least expensive, and rifaximin monotherapy was most expensive. When balancing cost and effectiveness, lactulose monotherapy and rifaximin salvage dominated alternative strategies. Compared to lactulose monotherapy, rifaximin salvage cost an incremental US$2315 per quality-adjusted life-year-gained. The cost of rifaximin had to fall below US$1.03/tab in order for rifaximin monotherapy to dominate lactulose monotherapy. CONCLUSIONS:
Rifaximin monotherapy is not cost-effective in the treatment of chronic hepatic encephalopathy at current average wholesale prices. However, a hybrid salvage strategy, reserving rifaximin for lactulose-refractory patients, may be highly cost-effective.
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Authors | E Huang, E Esrailian, B M R Spiegel |
Journal | Alimentary pharmacology & therapeutics
(Aliment Pharmacol Ther)
Vol. 26
Issue 8
Pg. 1147-61
(Oct 15 2007)
ISSN: 0269-2813 [Print] England |
PMID | 17894657
(Publication Type: Comparative Study, Journal Article, Research Support, N.I.H., Extramural, Research Support, U.S. Gov't, Non-P.H.S.)
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Chemical References |
- Gastrointestinal Agents
- Rifamycins
- Lactulose
- Rifaximin
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Topics |
- Cost-Benefit Analysis
- Female
- Gastrointestinal Agents
(economics, pharmacology, therapeutic use)
- Hepatic Encephalopathy
(diagnosis, drug therapy, economics)
- Hospitalization
(economics)
- Humans
- Lactulose
(economics, pharmacology, therapeutic use)
- Liver Failure
(complications, economics)
- Liver Transplantation
- Los Angeles
- Male
- Middle Aged
- Rifamycins
(economics, pharmacology, therapeutic use)
- Rifaximin
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