Overt hepatic encephalopathy in Italy: clinical outcomes and healthcare costs

Abstract

Daniela Paola Roggeri,1 Alessandro Roggeri,1 Elisa Rossi,2 Elisa Cinconze,2 Antonio Gasbarrini,3 PierAlessandro Monici Preti,4 Marisa De Rosa,2 1ProCure Solutions, Nembro, Bergamo, 2CINECA, Interuniversity Consortium, Bologna, 3Catholic University of Sacred Heart, Policlinic A Gemelli, Rome, 4Alfa Wassermann, Bologna, Italy Purpose: Hepatic encephalopathy (HE) is a recurrent severe complication of progressive hepatic cirrhosis. The aim of this study is to evaluate the average annual direct healthcare costs for the treatment of patients with overt HE in Italy. Patients and methods: This retrospective, observational study analyzed information from the database of ARNO Observatory. Patients with at least one hospitalization due to overt HE in the period from January 1, 2011 to December 31, 2011, were selected and observed during the year following the hospitalization. Costs for drugs, diagnostic and therapeutic procedures, and hospitalizations were estimated from the Italian National Health Service perspective. Results: Out of a population of 2,678,462 subjects, 381 patients were identified, of whom, 21.5% died during the first hospitalization and 5.8% during the follow-up; the survival rate was 72.7% at the end of the observation period. The direct healthcare costs per patient amounted to €13,393/year (15,295 USD) (88% for hospitalizations, 8% for drugs, and 4% for diagnostic procedures). During the follow-up, 42.5% of patients had at least one rehospitalization due to HE. Patients readmitted for HE had an average annual cost of €21,272 (24,293 USD), almost doubled if compared to patients without readmissions (€12,098 [13,816 USD]). Conclusion: This analysis showed that patients with HE had relevant direct healthcare costs, in which hospitalizations were the most important cost drivers. Keywords: hepatic encephalopathy, costs, hospitalizations, relapses