Abstract
BACKGROUND: Rifaximin treatment is associated with reduced rates of overt hepatic encephalopathy (OHE) hospitalization relative to lactulose alone. This real-world study evaluated the impact of treatment on rehospitalizations following an initial OHE hospitalization among commercial, Medicare, and Medicaid patients treated with rifaximin±lactulose or lactulose only. METHODS: Claims data from January 1, 2016, to September 30, 2023, were used to identify adults with an initial OHE hospitalization under commercial, Medicare, and/or Medicaid coverage (index date was the day following discharge). Patients were stratified into either the rifaximin cohort (±lactulose) or the lactulose-only cohort based on treatments received within 30 days following discharge. The 30-day OHE rehospitalization rate and OHE rehospitalization rate per-patient-per-year were compared between cohorts using adjusted logistic regression and negative binomial regressions, respectively. Subgroup analyses were conducted based on the timing of rifaximin treatment and adherence to treatment guidelines. RESULTS: The study included 7880 patients with an OHE hospitalization with commercial insurance (rifaximin: 5997; lactulose only: 1883), 4131 patients with Medicare insurance (rifaximin: 2419; lactulose only: 1712), and 2924 patients with Medicaid insurance (rifaximin: 1854; lactulose only: 1070). After adjustment, rifaximin was associated with a lower risk of 30-day OHE rehospitalization and lower OHE rehospitalization rates per-patient-per-year than lactulose in commercial (OR=1.75, incidence rate ratio [IRR]=1.67, respectively), Medicare (OR=1.61, IRR=1.51), and Medicaid (OR=1.50, IRR=1.54; all p<0.05) populations. Patients immediately receiving rifaximin and those with AASLD guideline-adherent escalation to rifaximin had the fewest rehospitalizations. CONCLUSIONS: Timely treatment with rifaximin in adherence with clinical practice guidelines following an initial OHE hospitalization was associated with improved short-term and longer-term rehospitalization outcomes, regardless of insurance type.