S1704 Impact of Rifaximin Use on Overt Hepatic Encephalopathy (OHE) Rehospitalizations Post-Discharge From an OHE Hospitalization in Commercially and Medicare-Insured Patients

Introduction: Overt hepatic encephalopathy (OHE) is a life-threatening neurologic complication of cirrhosis with a large medical resource burden. Patients with OHE often experience recurring episodes that require rehospitalization, further adding to patient morbidity. Therefore, it is imperative to better understand the impact of post-discharge rifaximin use on OHE rehospitalizations in patients with OHE in the US. Methods: Claims data from Komodo Research Dataset (1/2016 - 9/2023) were used to identify commercial and Medicare patients with an initial OHE hospitalization. Separately for each insurance sample, patients were classified into 2 mutually exclusive cohorts based on treatment received within 30 days of index hospitalization discharge: rifaximin (± lactulose) cohort or no rifaximin cohort. The impact of rifaximin use on 30-day OHE rehospitalization risk and annual OHE hospitalization rates was compared between cohorts (adjusted for patient characteristics). Results: In the commercial sample, 6,309 and 4,381 patients were included in the rifaximin and no rifaximin cohorts, respectively. Mean age was 54.5 (rifaximin) and 53.7 (no rifaximin) years; 39.5% and 44.6% were female. In each cohort, 584 (9.3%; rifaximin) and 326 (7.4%; no rifaximin) patients had Model for end-stage liver disease-Sodium (MELD-Na) scores, with a mean score of 17.3 and 17.1, respectively. After an initial OHE hospitalization, the 30-day OHE rehospitalization risk (11.1 vs 7.0%; adjusted odds ratio [OR] 1.66; Figure 1A) and annual OHE hospitalization rate (1.26 vs 0.81; adjusted incidence rate ratio [IRR] 1.56, both P < 0.01; Figure 1B) were higher for the no rifaximin vs rifaximin cohort. In the Medicare sample, 2,779 and 3,713 patients were included in the rifaximin (89.3% Medicare Advantage) and no rifaximin cohorts (92.6% Medicare Advantage), respectively. Mean age was 67.7 (rifaximin) and 69.3 (no rifaximin) years; 49.8% and 47.9% were female. In each cohort, 434 (15.6%; rifaximin) and 414 (11.2%; no rifaximin) patients had MELD-Na scores, with a mean score of 15.1 and 14.4, respectively. After an initial OHE hospitalization, the 30-day OHE rehospitalization risk (11.7 vs 7.0%; adjusted OR 1.78; Figure 1C) and annual OHE hospitalization rate (1.38 vs 0.84; adjusted IRR 1.63, both P < 0.01; Figure 1D) were higher for the no rifaximin vs rifaximin cohort. Conclusion: Timely initiation of rifaximin post-discharge was associated with reduced risk of 30-day rehospitalization and lower annualized rehospitalization rates in both commercially and Medicare insured patients.Figure 1.: Comparison between the rifaximin and no rifaximin cohorts of (A) 30-day risk of OHE rehospitalization and (B) annual OHE hospitalization rate in the commercial sample and (C) 30-day risk of OHE rehospitalization and (D) annual OHE hospitalization rate in the Medicare sample. *Significant at the 5% level. IRR: incidence rate ratio; OHE: overt hepatic encephalopathy; OR: odds ratio.

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