High out-of-pocket costs may lower rifaximin adherence for hepatic encephalopathy
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Key takeaways:
- Rifaximin retention decreased with time, with rates of 42% at 180 days dropping to 16% by 540 days.
- High cost, younger age, metastatic cancer and depression were factors associated with reduced retention.
Researchers reported low rifaximin treatment retention among patients with hepatic encephalopathy, with 30-day out-of-pocket treatment costs in excess of $150 among the factors associated with poor adherence.
“Rifaximin is beneficial given its use is associated with a decrease in the risk of recurrence of overt [hepatic encephalopathy (HE)], and of hospitalization, in those with two or more episodes of HE,” Elizabeth S. Aby, MD, of the division of gastroenterology, hepatology and nutrition at the University of Minnesota, and colleagues wrote in Hepatology Communications. “Although rifaximin has been demonstrated to be beneficial for HE, the drug cost remains a significant barrier to prescription adherence and therefore adequate therapy.”
They continued: “Although studies have demonstrated the impact of adherence on health care utilization and cost, no previous research has focused on the impact of [out-of-pocket (OOP)] cost on rifaximin medication adherence.”
In a retrospective cohort study, Aby and colleagues identified 6,839 patients (57.1% aged 55-64 years; 60.4% men) with cirrhosis and HE from the IBD MarketScan claims database. Of these, 4,274 patients were prescribed rifaximin between January 2011 and December 2021. Most patients (56%) underwent combined lactulose and rifaximin treatment while 6.5% received rifaximin alone.
Researchers used regression models to examine the relationship between 30-day OOP cost and retention (defined as ≥ 80 eligible days with rifaximin supply) at 180, 360 and 540 days. They selected $50, $50 to $150 and higher than $150 as cut-points to indicate low, medium and high OOP cost, which was the sum of associated co-pay, co-insurance and deductible.
Results revealed low treatment retention rates for rifaximin, which decreased with time from 42% at 180 days to 25% at 360 days and 16% at 540 days. Moreover, 30-day OOP costs of at least $150 were associated with a decreased likelihood of retention at each time point (RR = 0.67, RR = 0.62 and RR = 0.6, respectively). Researchers noted younger age also correlated with reduced retention at all time points.
Further, metastatic cancer (RR = 0.7; 95% CI, 0.52-0.93) and depression (RR = 0.87; 95% CI, 0.78-0.97) correlated with reduced retention during the first 180 days, while concomitant lactulose use (RR = 1.19; 95% CI, 1-1.4) correlated with increased retention during this time.
“In a commercially insured population, rates of rifaximin treatment retention are low and a high 30-day OOP cost (defined as ≥ $150) is associated with reduced rifaximin retention,” Aby and colleagues concluded. “Our research highlights the need for clinicians and policymakers to be aware of the impact of OOP costs on patients’ medication adherence and to take active measures to address this issue.”
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