Cost-effectiveness of screening and treatment protocols for treating hepatic encephalopathy in patients diagnosed...

A portion of patients diagnosed with dementia could instead have cirrhosis and reversible hepatic encephalopathy. Strategies to identify and treat reversible hepatic encephalopathy in patients currently diagnosed with dementia could prevent misdiagnosis and unnecessary healthcare resource use. Our intent was to determine cost-effectiveness of easily available strategies (Fibrosis-4:FIB-4) score, hepatic encephalopathy treatments (lactulose/rifaximin) and hepatology involvement for hepatic encephalopathy diagnosis in dementia patients.

This study evaluated the cost-effectiveness of screening and treatment strategies for hepatic encephalopathy in patients with dementia, using a decision-analytic model from a societal perspective. A decision tree model compared seven strategies over a 1-year time horizon. Six strategies (FIB-4 + empiric lactulose, FIB-4 + empiric rifaximin, FIB-4 + hepatology consult + lactulose, FIB-4 + hepatology consult + rifaximin, Empiric lactulose for all, empiric rifaximin for all) were compared to status quo.

Five of six intervention strategies showed higher effectiveness at lower cost versus status quo, with savings ranging from $6,160 to $13,236. The most economically efficient strategy was FIB-4 screening followed by hepatology consultation and targeted lactulose therapy, which generated cost savings and a gain in outcomes versus no screening. Sensitivity analyses confirmed robustness of screening strategies, with results most influenced by treatment response, utility values, and cirrhosis prevalence.

The combination of FIB-4 screening, hepatology referral, and lactulose therapy offers the best balance of value and clinical benefit, avoiding unnecessary overtreatment while capturing reversible hepatic encephalopathy. Targeted hepatic encephalopathy screening in dementia is cost-effective, improves diagnostic accuracy, reduces healthcare costs, and offers an opportunity to reverse cognitive impairment in individuals otherwise presumed to have irreversible dementia.