LAUSR

ABSTRACT Background and Aims Hepatic encephalopathy is a frequent complication of cirrhosis. Rifaximin‐α has been included in guidelines for secondary prevention of hepatic encephalopathy, but there are few real‐world data on its efficacy and impact on healthcare utilization. In this study, we aimed to assess the effect of rifaximin‐α on healthcare utilization. Method We conducted a cohort analysis in patients from seven hospitals in the Netherlands, who received rifaximin‐α as secondary prophylaxis for hepatic encephalopathy. Data were compared 6 months before and 6 months after the prescription of rifaximin‐α. The primary endpoint was the effect of rifaximin‐α on healthcare utilization. Secondary endpoint was the effect of rifaximin‐α on healthcare costs. Results We included 126 patients (65% male; median age 68) with a median Model for End‐stage Liver Disease score of 15. The mean number of hepatic encephalopathy episodes after starting rifaximin‐α was lower than before starting rifaximin‐α (0.9 vs. 2.2; p < 0.001). Mean healthcare utilization decreased from 6.1 contacts in the 6 months before rifaximin‐α to 3.3 contacts in the 6 months after starting rifaximin‐α (p < 0.001). The mean number of hospital admissions decreased from 1.7 admissions per patient to 1.0 admissions after starting rifaximin‐α (p < 0.001). The mean number of outpatient visits also decreased after starting rifaximin‐α (2.4 visits per patient to 1.7; p = 0.001). Annual costs per patient before starting rifaximin‐α were €13,320. This was similar to the costs after rifaximin‐α was prescribed (€13,120). Conclusion Rifaximin‐α significantly reduced the number of episodes of hepatic encephalopathy, the number of hospital admissions as well as the number of outpatient and emergency department visits, contributing to a reduction in healthcare utilization. There was no reduction in overall costs.