OBJECTIVES: To describe prevalence trends of hepatic encephalopathy (HE) in commercially insured adults with cirrhosis, HE treatment, hospitalization rates and associated costs in the United States (US) from 2006-2020.

METHODS: MarketScan® Commercial Claims Database was used to identify adults (18-64 years) with cirrhosis (≥2 diagnoses of cirrhosis or its complications) and HE, based on ICD-9 and/or ICD-10 codes. Annual prevalence of cirrhosis and HE were calculated from 2006 through 2020. The rates of lactulose only and rifaximin 550mg (± lactulose) use among patients with cirrhosis and rates and costs of HE-hospitalizations (i.e., inpatient stay with HE as primary diagnosis) were evaluated from 2006 through 2020. Costs (2020 USD) were adjusted for inflation using the medical consumer price index.

RESULTS: Since 2006, the rate of cirrhosis increased by 5.2% year-over-year ([YOY]; 0.20% [2006] to 0.45% [2020]; p<0.001) and the prevalence of HE among patients with cirrhosis increased by 4.3% YOY (11.8% [2006] to 21.4% [2020]; p<0.001). The rate of rifaximin 550mg use among patients with cirrhosis has increased since FDA approval in 2010 and has stabilized around 6.5% starting in 2015. Among patients with HE, the rate of HE-hospitalizations declined from 32.3% (2006) to 5.5% (2020; p<0.001). Sensitivity analyses using different definitions of HE-hospitalizations were consistent with the trend for the main definition. The cost of HE-hospitalizations increased by 4.6% YOY from $39,333 (2010) to $77,699 (2020), and by 8.1% YOY from 2015-2020.

CONCLUSIONS: This study highlights that HE-hospitalizations declined while associated costs remained stable from 2006-2015 and have more than doubled since 2015, resulting in an estimated total HE-hospitalizations cost of ~$800 million (2020). Studies are warranted to understand the observed decline in HE-hospitalization, which may be associated with changes in screening/monitoring guidelines, increased disease awareness, or introduction of treatments targeting HE recurrence.