Quantifying treatment value under IRA: a case study of rifaximin for the treatment of overt hepatic encephalopathy using QALY and non-QALY measures
Bibliographic record
Abstract
BACKGROUND: Traditional cost effectiveness analyses frequently use quality-adjusted life years (QALYs) to quantify health benefits. The Medicare Drug Price Negotiation program, however, cannot use QALYs, but may consider alternative, non-discriminatory metrics. OBJECTIVE: To examine the impact of using alternative quantitative health benefit metrics on the economic value of new medications. The framework was applied to assess the cost-effectiveness of rifaximin for preventing overt hepatic encephalopathy (OHE) recurrence in adults. METHODS: A cost-effectiveness analysis evaluated the economic value of rifaximin ± lactulose versus standard of care ± lactulose in preventing recurrent OHE in adults over a lifetime horizon from US payer and societal perspectives. Clinical outcomes included time in remission and overt health states, number of liver transplants, and life years (LYs). Health benefit was quantified using QALYs, health years in total (HYT), equal-value of life years gained (evLYG), and generalized risk-adjusted cost-effectiveness (GRACE). Treatment value was measured using incremental cost effectiveness ratio (ICER). A societal perspective scenario added productivity and caregiving impacts to the model. RESULTS: Rifaximin patients spent >3 times as long in remission (54.4 vs. 17.3 months), comparable time in the overt health state (1.44 vs. 1.44 months), and had twice as many liver transplants (20 vs. 9), driven by longer survival (8.80 vs. 4.17 LYs), resulting in incremental gains of 3.12 QALYs, 3.26 HYT, 2.78 evLYG, and 3.16 GRA-QALYs. Total costs were higher with rifaximin ($182,369 vs. $38,313, Δ = $144,056), mainly due to drug costs (Δ = $133,330). Including caregiving and productivity reduced the incremental cost to $136,866. From a payer perspective, rifaximin ICERs were $46,215/QALY, $44,198/HYT, $51,847/evLYG, and $45,609/GRA-QALY. After incorporating societal costs, ICERs improved to $43,908/QALY, $41,992/HYT, $49,259/evLYG, and $43,332/GRA-QALY. CONCLUSION: Rifaximin is a cost-effective treatment for preventing OHE recurrence in adults using QALY and non-QALY health benefit measures.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".