High cost of hepatic encephalopathy treatment may lead to medication non-adherence

Reviewed by Danielle Ellis, B.Sc.Aug 25 2023

Researchers from the University of Minnesota Medical School and College of Pharmacy have found that high costs for hepatic encephalopathy treatment in patients with end-stage liver disease were associated with decreased treatment retention for patients. The study results were recently published in Hepatology Communications.

Hepatic encephalopathy is the loss of brain function that occurs in people with severe liver disease. The condition is associated with high morbidity and mortality. The drug treatment rifaximin is commonly used to treat hepatic encephalopathy, yet treatment retention remains low.

Our research demonstrates that the cost of rifaximin is too high in the United States. Individuals with scarred livers, who have a higher out-of-pocket cost, are more likely to not fill their prescription for their medication, which can result in falls, hospitalizations and other poor outcomes. Clinicians and policy makers need to be aware of the impact that out-of-pocket costs have on patients' medication adherence for rifaximin. Active measures must be taken to address this issue."

Elizabeth Aby, MD, Assistant Professor at the University of Minnesota Medical School and transplant hepatologist at M Health Fairview

The study included more than 6,800 patients with cirrhosis -; a condition where the liver is scarred from long term damage -; and hepatic encephalopathy. The research team's analysis found patients who are younger and have metastatic cancer or depression are less likely to take their medication.

The research team suggests clinicians screen patients for financial insecurity and the potentially harmful effect the high cost of treatment could have on the patient, as well as involving social workers and financial assistance early. Additionally, further steps are needed to lower the cost of the drug.