Treating Hepatic Encephalopathy Reduces Costs Due to MVAs

Diagnosis and lactulose treatment linked to reduced motor vehicle accident-related costs

FRIDAY, April 6 (HealthDay News) -- For patients with minimal hepatic encephalopathy (MHE), diagnosis and treatment with lactulose reduces costs associated with motor vehicle accidents (MVAs), according to a study published in the April issue of Hepatology.

Noting that MHE in cirrhosis is linked with impaired driving skills and increased risk of MVAs, Jasmohan S. Bajaj, M.D., of Virginia Commonwealth University and McGuire VA Medical Center in Richmond, and associates assessed the benefits of five strategies of MHE diagnosis and treatment. Using a Markov model they followed a simulated cohort of 1,000 patients with cirrhosis without overt HE from entry to treatment, through MHE development. The strategies included presumptive treatment of all patients with cirrhosis; diagnosis by neuropsychological exam (NPE), standard psychometric tests (SPT), or rapid screening using inhibitory control test (ICT) -- all with treatment; or no diagnosis or treatment. Lactulose and rifaximin were considered as treatments, which were assumed to reduce the rate of MVAs.

The researchers found that, compared with status quo, use of all four strategies with lactulose were cost-saving. The most cost-effective approach was diagnosis with ICT followed by lactulose treatment (cost per MVA prevented: $24,454 with ICT versus $25,470 with SPT, $30,469 with presumptive treatment, and $33,742 with NPE). Depending on the strategy, over five years, the savings ranged from $1.7 to $3.6 million. Treatment with rifaximin was not cost-saving, but would be if the monthly cost could be reduced to less than $353.

"Detection of MHE, especially using the ICT, and subsequent treatment with lactulose could substantially reduce societal costs by preventing MVAs," the authors conclude.

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