PMID- 22135042
OWN - NLM
STAT- MEDLINE
DCOM- 20120522
LR  - 20211021
IS  - 1527-3350 (Electronic)
IS  - 0270-9139 (Print)
IS  - 0270-9139 (Linking)
VI  - 55
IP  - 4
DP  - 2012 Apr
TI  - Diagnosis and treatment of minimal hepatic encephalopathy to prevent motor 
      vehicle accidents: a cost-effectiveness analysis.
PG  - 1164-71
LID - 10.1002/hep.25507 [doi]
AB  - Minimal hepatic encephalopathy (MHE) in cirrhosis is associated with impaired 
      driving skills and increased risk of motor vehicle accidents (MVAs). Detection 
      and treatment of MHE has the potential to reduce costs and morbidity associated 
      with MVAs. We conducted a cost-effectiveness analysis to assess the benefits of 
      different strategies of MHE diagnosis and treatment for reducing MVA-related 
      societal costs. The analyses compared five MHE management strategies: (1) 
      presumptive treatment of all cirrhosis patients; (2) diagnosis by 
      neuropsychological exam (NPE) with treatment; (3) diagnosis by standard 
      psychometric tests (SPTs) with treatment; (4) diagnosis by rapid screening using 
      inhibitory control test (ICT) with treatment; and (5) no MHE diagnosis or 
      treatment (status quo). Treatments considered were lactulose or rifaximin, which 
      were assumed to reduce the MVA rate to the level of similarly aged noncirrhosis 
      patients with benefit adjusted for treatment compliance. A Markov model followed 
      a simulated cohort of 1,000 cirrhosis patients without overt hepatic 
      encephalopathy (OHE), from entry into treatment, through MHE development, and 
      later OHE, when they exited the modeled cohort. Follow-up was for 5 years and 
      included biannual MHE testing. The societal cost of a single MVA was estimated at 
      $42,100. All four strategies with lactulose were cost-saving compared with the 
      status quo. Diagnosis with ICT and lactulose was the most cost-effective approach 
      (cost/MVA prevented: $24,454 ICT; $25,470 SPT; $30,469 presumptive treatment and 
      $33,742 NPE). Net program savings over 5 years ranged from $1.7 to 3.6 million 
      depending on the strategy. Rifaximin therapy was not cost-saving at current 
      prices but would become so at a monthly cost of <$353. CONCLUSION: Detection of 
      MHE, especially using the ICT, and subsequent treatment with lactulose could 
      substantially reduce societal costs by preventing MVAs.
CI  - Copyright (c) 2011 American Association for the Study of Liver Diseases.
FAU - Bajaj, Jasmohan S
AU  - Bajaj JS
AD  - Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth 
      University and McGuire VA Medical Center, Richmond, VA 23249, USA. 
      jsbajaj@vcu.edu
FAU - Pinkerton, Steven D
AU  - Pinkerton SD
FAU - Sanyal, Arun J
AU  - Sanyal AJ
FAU - Heuman, Douglas M
AU  - Heuman DM
LA  - eng
GR  - P30 MH052776/MH/NIMH NIH HHS/United States
GR  - R01DK087913/DK/NIDDK NIH HHS/United States
GR  - U01 AT004428/AT/NCCIH NIH HHS/United States
GR  - P30 MH052776-06/MH/NIMH NIH HHS/United States
GR  - U01 AT004428-01A1/AT/NCCIH NIH HHS/United States
GR  - R01 AA020203/AA/NIAAA NIH HHS/United States
GR  - R01 DK087913/DK/NIDDK NIH HHS/United States
GR  - U01AT004428/AT/NCCIH NIH HHS/United States
GR  - R01 AA020203-01/AA/NIAAA NIH HHS/United States
GR  - P30MH52776/MH/NIMH NIH HHS/United States
GR  - R01 DK087913-01A1/DK/NIDDK NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Hepatology
JT  - Hepatology (Baltimore, Md.)
JID - 8302946
RN  - 0 (Gastrointestinal Agents)
RN  - 0 (Rifamycins)
RN  - 4618-18-2 (Lactulose)
RN  - L36O5T016N (Rifaximin)
SB  - IM
CIN - Hepatology. 2012 Apr;55(4):985-7. PMID: 22234933
MH  - Accidents, Traffic/*economics/*prevention & control
MH  - Aged
MH  - Cohort Studies
MH  - Cost-Benefit Analysis
MH  - Follow-Up Studies
MH  - Gastrointestinal Agents/*economics/*therapeutic use
MH  - Hepatic Encephalopathy/*diagnosis/*drug therapy/etiology
MH  - Humans
MH  - Lactulose/economics/therapeutic use
MH  - Liver Cirrhosis/complications
MH  - Markov Chains
MH  - Middle Aged
MH  - Neuropsychological Tests
MH  - Psychometrics
MH  - Rifamycins/economics/therapeutic use
MH  - Rifaximin
MH  - *Severity of Illness Index
MH  - United States
PMC - PMC3319334
MID - NIHMS341778
EDAT- 2011/12/03 06:00
MHDA- 2012/05/23 06:00
PMCR- 2013/04/01
CRDT- 2011/12/03 06:00
PHST- 2011/12/03 06:00 [entrez]
PHST- 2011/12/03 06:00 [pubmed]
PHST- 2012/05/23 06:00 [medline]
PHST- 2013/04/01 00:00 [pmc-release]
AID - 10.1002/hep.25507 [doi]
PST - ppublish
SO  - Hepatology. 2012 Apr;55(4):1164-71. doi: 10.1002/hep.25507.