Cost-effectiveness of Rifaximin treatment in patients with advanced fibrosis who maintain excessive alcohol consumption.
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Notice bibliographique
Résumé
Background & aimsThe ability of Rifaximin to modulate gut microbiota makes it the first potential treatment for early stages of alcohol-related liver disease (ALD)-i.e., advanced fibrosis and compensated cirrhosis.The present study aims to investigate what effect Rifaximin treatment has to have in order to be cost-effective. MethodsA partitioned survival model was developed to simulate a sample of ongoing excessive drinkers with advanced fibrosis (F3-4) over their lifetime.The costs (in 2021 US$) and benefits in terms of quality-adjusted life years (QALYs) gained were estimated from the healthcare perspective.The corresponding healthcare costs were taken from the Danish DRG.The OS and PFS curves were based on the data from the GALA-ALD natural history data, and utilities were estimated from the previously published studies.We estimated what effect Rifaximin treatment has to have in order to be a cost-effective treatment option.Furthermore, we conducted deterministic and scenario analysis, as well as one-way and probabilistic sensitivity analysis to investigate the impact of parameter uncertainty, and value of information analysis was performed to estimate the value of further clinical research aiming to reduce decision uncertainty. ResultsCompared to the standard care, Rifaximin treatment was found to be cost-effective at a willingness-to-pay threshold (WTP) of $48,000 (equivalent of 40,000) per QALY if the intervention increases the disease-free survival (DFS) by at least 3.7%.3.7% is the pivot point for cost-effectiveness, therefore, the higher the Rifaximin effect is, the higher are the chances that it will be cost-effective.The results of our sensitivity and scenario analysis confirmed robustness of the main findings. ConclusionsIt is important to prevent progression of early ALD disease which, upon reaching the stage of decompensated cirrhosis, is considered to be irreversible and is associated with very high costs and mortality rates. LAY SUMMARYRifaximin can improve the outcomes of ongoing excessive drinkers with advanced fibrosis (F3-4) by delaying or preventing the transition of these patients to decompensation and, subsequently, death state.A wider use of Rifaximin treatment should be determined based on the outcomes from Rifaximin clinical trial and evaluation of whether or not the intervention increases DFS by at least 3.7%.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découle