Currently Viewing:
Supplements Considerations for the Cost-Effective Management of Hepatic Encephalopathy
Currently Reading
Considerations for the Cost-Effective Management of Hepatic Encephalopathy
Steven L. Flamm, MD

Considerations for the Cost-Effective Management of Hepatic Encephalopathy

Steven L. Flamm, MD
Hepatic encephalopathy (HE) is a neuropsychiatric complication commonly associated with liver disease, namely cirrhosis. The inability of the liver to metabolize ammonia results in a buildup of ammonia, which can cross the blood–brain barrier and cause significant neurocognitive impairment. Up to 80% of patients with cirrhosis will experience HE and a large proportion of these patients are at high risk of recurrent HE. There are several factors to consider when developing a cost-effective approach to managing HE, such as patient compliance, the adverse event (AE) profile of drug therapy, efficacy of drug therapy, and relative cost–benefits of drug therapy. Pharmacologic agents used for HE treatment and prevention are commonly associated with gastrointestinal AEs, namely diarrhea. While these AEs are mild in nature, they can be bothersome and lead to patient noncompliance, which increases the patient’s risk of HE. Furthermore, the complex dosing schedule and self-titration requirement of lactulose, a first-line agent, can be confusing to a patient. A patient’s noncompliance with self-titration may result in underuse, increasing the patient’s risk of HE, or overuse, increasing the patient’s risk of severe AEs. HE imposes a significant economic burden to the patient, patients’ caregivers, healthcare systems, and society. HE not only negatively impacts a patient’s morbidity and mortality, but also impacts the patient’s psychological and social functioning and overall quality of life. HE can impact the patient’s ability to work, resulting in reduced productivity and lost wages. A patient with HE may require hospitalization, which accounts for a substantial proportion of costs associated with HE. Given the social and financial burden of HE, cost-effective management of HE is crucial. Early prevention is important to minimize the societal and economic costs associated with HE.
Am J Manag Care. 2018;24:-S0

Become a Member to see the rest of this article and get access to all of our articles and resources. Membership is Free!

Register
Login
 
Copyright AJMC 2006-2018 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
x
Welcome the the new and improved AJMC.com, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up