This is the title of my new publication published today subtitled “A case study of rifaximin for the treatment of overt hepatic encephalopathy using QALY and non-QALY measures”. It was a work with co-authors Shanshan Wang, Leonardo Passos Chaves, Olamide Olujohungbe, Sanjana Muthukrishnan and Aditi Chaudhary. The gist is below.
background
Traditional cost-effectiveness analyzes often use quality-adjusted life years (QALYs) to quantify health benefits. However, the Medicare Drug Price Negotiation Program cannot use QALYs, but may consider alternative, non-discriminatory metrics.
Objective
Investigating the impact of using alternative quantitative health benefit metrics on the economic value of new medicines. The framework was applied to assess the cost-effectiveness of rifaximin for preventing recurrence of overt hepatic encephalopathy (OHE) in adults.
methods
A cost-effectiveness analysis evaluated the economic value of rifaximin ± lactulose versus standard of care ± lactulose in preventing recurrent OHE across the lifespan in adults from a US payer and societal perspective. Clinical outcomes included time in remission and apparent health status, number of liver transplants, and life years (LY). Health benefits were quantified using QALYs, total health years (HYT), equivalent value of life years gained (evLYG), and generalized risk-adjusted cost-effectiveness (GRACE). Treatment value was measured using incremental cost-effectiveness ratio (ICER). A social perspective scenario added productivity and caregiving effects to the model.
Result
Rifaximin patients spent more than 3 times as long in remission (54.4 vs 17.3 months), had comparable time in manifest health status (1.44 vs 1.44 months), and had twice as many liver transplants (20 vs 9), which were driven by longer survival (8.80 vs 4.17 LY), resulting in 3.12 QALYs, 3.26 HYT, There was an incremental profit of Rs 2.78. evLYG, and 3.16 GRA-QALYs. Total costs were higher with rifaximin ($182,369 vs. $38,313, Δ = $144,056), primarily due to drug cost (Δ = $133,330). Including care and productivity reduced the incremental cost to $136,866. From the payer perspective, rifaximin ICERs were $46,215/QALY, $44,198/HYT, $51,847/evLYG, and $45,609/GRA-QALY. After including societal costs, the ICERs improved to $43,908/QALY, $41,992/HYT, $49,259/evLYG, and $43,332/GRA-QALY.
conclusion
Rifaximin is a cost-effective treatment to prevent OHE recurrence in adults using QALY and non-QALY health gain measures.
You can read the full paper Here,
