Author information

1 Liver Unit, Freeman Hospital, Newcastle upon Tyne, UK. 2 UK Medical Affairs, Norgine, Harefield, UK. 3 pH Associates, Marlow, UK. 4 NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases at Nottingham University Hospitals NHS Trust and The University of Nottingham, Nottingham, UK. 5 Department of Gastroenterology, Ninewells Hospital and The School of Medicine, University of Dundee, Dundee, UK. 6 The Liver Unit, Royal Victoria Hospital, Belfast, UK. 7 Department of Gastroenterology, Southmead Hospital, Bristol, UK. 8 Department of Hepatology, University Hospital Southampton, Southampton, UK. 9 Institute of Liver Studies and Transplantation, King's College London School of Medicine at King's College Hospital, London, UK. 10 Liver Failure Group, University College London Institute for Liver and Digestive Health, Royal Free Hospital, London, UK. 11 Department of Gastroenterology, University Hospital of North Durham, Durham, UK. 12 Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK. 13 Department of Gastroenterology and Hepatology, Royal Liverpool & Broadgreen University Hospitals NHS Trust, Liverpool, UK. 14 Department of Gastroenterology & Hepatology, Royal Cornwall Hospital, Cornwall, UK. 15 Department of Gastroenterology & Hepatology, Queen Alexandra Hospital, Portsmouth, UK.

Abstract

OBJECTIVE: To compare all-cause and liver-related hospital resource use in the 6 and 12 months pre-rifaximin-α and post-rifaximin-α initiation in UK patients with hepatic encephalopathy (HE).

DESIGN: A UK multicentre, retrospective, observational study. Patients' medical records were reviewed for demographics, clinical outcomes and adverse events (AEs) to rifaximin-α. Details of hospital admissions/attendances in the 6 and 12 months pre-rifaximin-α and post-rifaximin-α initiation were extracted from hospital electronic databases.

SETTING: 13 National Health Service centres.

PATIENTS: 207 patients with HE who initiated rifaximin-α between July 2008 and May 2014. Hospital resource use data were available for 145/207 patients.

MAIN OUTCOME MEASURE: Change in mean number of liver-related hospital bed days/patient (total and critical care) between the 6 months pre-rifaximin-α and post-rifaximin-α initiation.

RESULTS: Comparing the 6 months pre-rifaximin-α and post-rifaximin-α initiation in alive patients at the end of the observation period (N=114): there were significant reductions in the mean number of hospitalisations/patient (liver-related 1.3 to 0.5, p<0.001; all-cause 1.9 to 0.9, p<0.001), hospital bed days/patient (liver-related 17.8 to 6.8, p<0.001; all-cause 25.4 to 10.6, p<0.001), 30-day hospital readmissions/patient (liver-related 0.5 to 0.2, p=0.039; all-cause 0.8 to 0.4, p=0.024) and emergency department (ED) attendances/patient (all-cause, 1.0 to 0.5, p<0.001). The mean critical care bed days/patient reduced significantly for all-cause admissions (1.3 to 0.3, p=0.049); non-significant reduction for liver-related admissions. 4% of patients (9/207) developed AEs.

CONCLUSIONS: In UK clinical practice, treatment with rifaximin-α for HE is well-tolerated and associated with significant reductions in hospitalisations, bed days (including critical care), ED attendances and 30-day readmissions.