MINNEAPOLIS/ST. PAUL (08/24/2023) — 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,” said Elizabeth Aby, MD, an assistant professor at the University of Minnesota Medical School and transplant hepatologist at M Health Fairview. “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.”

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. 


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The University of Minnesota Medical School is at the forefront of learning and discovery, transforming medical care and educating the next generation of physicians. Our graduates and faculty produce high-impact biomedical research and advance the practice of medicine. We acknowledge that the U of M Medical School, both the Twin Cities campus and Duluth campus, is located on traditional, ancestral and contemporary lands of the Dakota and the Ojibwe, and scores of other Indigenous people, and we affirm our commitment to tribal communities and their sovereignty as we seek to improve and strengthen our relations with tribal nations. For more information about the U of M Medical School, please visit med.umn.edu