The impact of rifaximin-α on the hospital resource use associated with the management of patients with hepatic encephalopathy: a retrospective observational study (IMPRESS)

Mark Hudson; Amr Radwan; Paola Di Maggio; Riccardo Cipelli; Stephen D. Ryder; John F. Dillon; William Jonathan Cash; Robert T. Przemioslo; Mark Wright; Debbie L. Shawcross; Rajiv Jalan; Sushma Saksena; Michael Allison; Paul Richardson; Elizabeth Farrington; Richard J. Aspinall

doi:10.1136/flgastro-2016-100792

The impact of rifaximin-α on the hospital resource use associated with the management of patients with hepatic encephalopathy: a retrospective observational study (IMPRESS)

Mark Hudson, Amr Radwan, Paola Di Maggio (Lead / Corresponding author), Riccardo Cipelli, Stephen D. Ryder, John F. Dillon, William Jonathan Cash, Robert T. Przemioslo, Mark Wright, Debbie L. Shawcross, Rajiv Jalan, Sushma Saksena, Michael Allison, Paul Richardson, Elizabeth Farrington, Richard J. Aspinall

Molecular and Clinical Medicine

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Abstract

Objective: To compare all-cause and liver-related hospital resource use in the 6 and 12 months pre-rifaximin-α and post-rifaximin-α initiation in UK patients with hepatic encephalopathy (HE).

Design: A UK multicentre, retrospective, observational study. Patients' medical records were reviewed for demographics, clinical outcomes and adverse events (AEs) to rifaximin-α. Details of hospital admissions/attendances in the 6 and 12 months pre-rifaximin-α and post-rifaximin-α initiation were extracted from hospital electronic databases.

Setting: 13 National Health Service centres.

Patients: 207 patients with HE who initiated rifaximin-α between July 2008 and May 2014. Hospital resource use data were available for 145/207 patients.

Main outcome measure: Change in mean number of liver-related hospital bed days/patient (total and critical care) between the 6 months pre-rifaximin-α and post-rifaximin-α initiation.

Results: Comparing the 6 months pre-rifaximin-α and post-rifaximin-α initiation in alive patients at the end of the observation period (N=114): there were significant reductions in the mean number of hospitalisations/patient (liver-related 1.3 to 0.5, p<0.001; all-cause 1.9 to 0.9, p<0.001), hospital bed days/patient (liver-related 17.8 to 6.8, p<0.001; all-cause 25.4 to 10.6, p<0.001), 30-day hospital readmissions/patient (liver-related 0.5 to 0.2, p=0.039; all-cause 0.8 to 0.4, p=0.024) and emergency department (ED) attendances/patient (all-cause, 1.0 to 0.5, p<0.001). The mean critical care bed days/patient reduced significantly for all-cause admissions (1.3 to 0.3, p=0.049); non-significant reduction for liver-related admissions. 4% of patients (9/207) developed AEs.

Conclusions: In UK clinical practice, treatment with rifaximin-α for HE is well-tolerated and associated with significant reductions in hospitalisations, bed days (including critical care), ED attendances and 30-day readmissions.

Original language	English
Pages (from-to)	243-251
Number of pages	9
Journal	Frontline Gastroenterology
Volume	8
Issue number	4
Early online date	7 Apr 2017
DOIs	https://doi.org/10.1136/flgastro-2016-100792
Publication status	Published - Oct 2017

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Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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Hudson, M., Radwan, A., Di Maggio, P., Cipelli, R., Ryder, S. D., Dillon, J. F., Cash, W. J., Przemioslo, R. T., Wright, M., Shawcross, D. L., Jalan, R., Saksena, S., Allison, M., Richardson, P., Farrington, E., & Aspinall, R. J. (2017). The impact of rifaximin-α on the hospital resource use associated with the management of patients with hepatic encephalopathy: a retrospective observational study (IMPRESS). Frontline Gastroenterology, 8(4), 243-251. https://doi.org/10.1136/flgastro-2016-100792

@article{1d28ce482ea84892bc9eac3a7c39d00c,

title = "The impact of rifaximin-α on the hospital resource use associated with the management of patients with hepatic encephalopathy: a retrospective observational study (IMPRESS)",

abstract = "Objective: To compare all-cause and liver-related hospital resource use in the 6 and 12 months pre-rifaximin-α and post-rifaximin-α initiation in UK patients with hepatic encephalopathy (HE).Design: A UK multicentre, retrospective, observational study. Patients' medical records were reviewed for demographics, clinical outcomes and adverse events (AEs) to rifaximin-α. Details of hospital admissions/attendances in the 6 and 12 months pre-rifaximin-α and post-rifaximin-α initiation were extracted from hospital electronic databases.Setting: 13 National Health Service centres.Patients: 207 patients with HE who initiated rifaximin-α between July 2008 and May 2014. Hospital resource use data were available for 145/207 patients.Main outcome measure: Change in mean number of liver-related hospital bed days/patient (total and critical care) between the 6 months pre-rifaximin-α and post-rifaximin-α initiation.Results: Comparing the 6 months pre-rifaximin-α and post-rifaximin-α initiation in alive patients at the end of the observation period (N=114): there were significant reductions in the mean number of hospitalisations/patient (liver-related 1.3 to 0.5, p<0.001; all-cause 1.9 to 0.9, p<0.001), hospital bed days/patient (liver-related 17.8 to 6.8, p<0.001; all-cause 25.4 to 10.6, p<0.001), 30-day hospital readmissions/patient (liver-related 0.5 to 0.2, p=0.039; all-cause 0.8 to 0.4, p=0.024) and emergency department (ED) attendances/patient (all-cause, 1.0 to 0.5, p<0.001). The mean critical care bed days/patient reduced significantly for all-cause admissions (1.3 to 0.3, p=0.049); non-significant reduction for liver-related admissions. 4% of patients (9/207) developed AEs.Conclusions: In UK clinical practice, treatment with rifaximin-α for HE is well-tolerated and associated with significant reductions in hospitalisations, bed days (including critical care), ED attendances and 30-day readmissions.",

author = "Mark Hudson and Amr Radwan and {Di Maggio}, Paola and Riccardo Cipelli and Ryder, {Stephen D.} and Dillon, {John F.} and Cash, {William Jonathan} and Przemioslo, {Robert T.} and Mark Wright and Shawcross, {Debbie L.} and Rajiv Jalan and Sushma Saksena and Michael Allison and Paul Richardson and Elizabeth Farrington and Aspinall, {Richard J.}",

note = "This study was sponsored and funded by Norgine. Norgine personnel were involved in the design of the study, analysis and interpretation of the study data, review of the draft manuscript and approval of the final version. pH Associates, an independent research consultancy, was commissioned by Norgine to provide support with the design and conduct of the study, data analysis and medical writing.",

year = "2017",

month = oct,

doi = "10.1136/flgastro-2016-100792",

language = "English",

volume = "8",

pages = "243--251",

journal = "Frontline Gastroenterology",

issn = "2041-4137",

publisher = "BMJ Publishing Group",

number = "4",

}

Hudson, M, Radwan, A, Di Maggio, P, Cipelli, R, Ryder, SD, Dillon, JF, Cash, WJ, Przemioslo, RT, Wright, M, Shawcross, DL, Jalan, R, Saksena, S, Allison, M, Richardson, P, Farrington, E & Aspinall, RJ 2017, 'The impact of rifaximin-α on the hospital resource use associated with the management of patients with hepatic encephalopathy: a retrospective observational study (IMPRESS)', Frontline Gastroenterology, vol. 8, no. 4, pp. 243-251. https://doi.org/10.1136/flgastro-2016-100792

The impact of rifaximin-α on the hospital resource use associated with the management of patients with hepatic encephalopathy: a retrospective observational study (IMPRESS). / Hudson, Mark; Radwan, Amr; Di Maggio, Paola (Lead / Corresponding author) et al.
In: Frontline Gastroenterology, Vol. 8, No. 4, 10.2017, p. 243-251.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - The impact of rifaximin-α on the hospital resource use associated with the management of patients with hepatic encephalopathy

T2 - a retrospective observational study (IMPRESS)

AU - Hudson, Mark

AU - Radwan, Amr

AU - Di Maggio, Paola

AU - Cipelli, Riccardo

AU - Ryder, Stephen D.

AU - Dillon, John F.

AU - Cash, William Jonathan

AU - Przemioslo, Robert T.

AU - Wright, Mark

AU - Shawcross, Debbie L.

AU - Jalan, Rajiv

AU - Saksena, Sushma

AU - Allison, Michael

AU - Richardson, Paul

AU - Farrington, Elizabeth

AU - Aspinall, Richard J.

N1 - This study was sponsored and funded by Norgine. Norgine personnel were involved in the design of the study, analysis and interpretation of the study data, review of the draft manuscript and approval of the final version. pH Associates, an independent research consultancy, was commissioned by Norgine to provide support with the design and conduct of the study, data analysis and medical writing.

PY - 2017/10

Y1 - 2017/10

N2 - Objective: To compare all-cause and liver-related hospital resource use in the 6 and 12 months pre-rifaximin-α and post-rifaximin-α initiation in UK patients with hepatic encephalopathy (HE).Design: A UK multicentre, retrospective, observational study. Patients' medical records were reviewed for demographics, clinical outcomes and adverse events (AEs) to rifaximin-α. Details of hospital admissions/attendances in the 6 and 12 months pre-rifaximin-α and post-rifaximin-α initiation were extracted from hospital electronic databases.Setting: 13 National Health Service centres.Patients: 207 patients with HE who initiated rifaximin-α between July 2008 and May 2014. Hospital resource use data were available for 145/207 patients.Main outcome measure: Change in mean number of liver-related hospital bed days/patient (total and critical care) between the 6 months pre-rifaximin-α and post-rifaximin-α initiation.Results: Comparing the 6 months pre-rifaximin-α and post-rifaximin-α initiation in alive patients at the end of the observation period (N=114): there were significant reductions in the mean number of hospitalisations/patient (liver-related 1.3 to 0.5, p<0.001; all-cause 1.9 to 0.9, p<0.001), hospital bed days/patient (liver-related 17.8 to 6.8, p<0.001; all-cause 25.4 to 10.6, p<0.001), 30-day hospital readmissions/patient (liver-related 0.5 to 0.2, p=0.039; all-cause 0.8 to 0.4, p=0.024) and emergency department (ED) attendances/patient (all-cause, 1.0 to 0.5, p<0.001). The mean critical care bed days/patient reduced significantly for all-cause admissions (1.3 to 0.3, p=0.049); non-significant reduction for liver-related admissions. 4% of patients (9/207) developed AEs.Conclusions: In UK clinical practice, treatment with rifaximin-α for HE is well-tolerated and associated with significant reductions in hospitalisations, bed days (including critical care), ED attendances and 30-day readmissions.

AB - Objective: To compare all-cause and liver-related hospital resource use in the 6 and 12 months pre-rifaximin-α and post-rifaximin-α initiation in UK patients with hepatic encephalopathy (HE).Design: A UK multicentre, retrospective, observational study. Patients' medical records were reviewed for demographics, clinical outcomes and adverse events (AEs) to rifaximin-α. Details of hospital admissions/attendances in the 6 and 12 months pre-rifaximin-α and post-rifaximin-α initiation were extracted from hospital electronic databases.Setting: 13 National Health Service centres.Patients: 207 patients with HE who initiated rifaximin-α between July 2008 and May 2014. Hospital resource use data were available for 145/207 patients.Main outcome measure: Change in mean number of liver-related hospital bed days/patient (total and critical care) between the 6 months pre-rifaximin-α and post-rifaximin-α initiation.Results: Comparing the 6 months pre-rifaximin-α and post-rifaximin-α initiation in alive patients at the end of the observation period (N=114): there were significant reductions in the mean number of hospitalisations/patient (liver-related 1.3 to 0.5, p<0.001; all-cause 1.9 to 0.9, p<0.001), hospital bed days/patient (liver-related 17.8 to 6.8, p<0.001; all-cause 25.4 to 10.6, p<0.001), 30-day hospital readmissions/patient (liver-related 0.5 to 0.2, p=0.039; all-cause 0.8 to 0.4, p=0.024) and emergency department (ED) attendances/patient (all-cause, 1.0 to 0.5, p<0.001). The mean critical care bed days/patient reduced significantly for all-cause admissions (1.3 to 0.3, p=0.049); non-significant reduction for liver-related admissions. 4% of patients (9/207) developed AEs.Conclusions: In UK clinical practice, treatment with rifaximin-α for HE is well-tolerated and associated with significant reductions in hospitalisations, bed days (including critical care), ED attendances and 30-day readmissions.

U2 - 10.1136/flgastro-2016-100792

DO - 10.1136/flgastro-2016-100792

M3 - Article

C2 - 29067149

SN - 2041-4137

VL - 8

SP - 243

EP - 251

JO - Frontline Gastroenterology

JF - Frontline Gastroenterology

IS - 4

ER -

The impact of rifaximin-α on the hospital resource use associated with the management of patients with hepatic encephalopathy: a retrospective observational study (IMPRESS)

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