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In contrast, rifaximin is safe and effective in hepatic encephalopathy, but is more expensive.<\/jats:p><jats:p><jats:bold>Methods\u2002<\/jats:bold>We conducted a decision analysis to calculate the cost\u2010effectiveness of six strategies in hepatic encephalopathy: (i) no hepatic encephalopathy treatment, (ii) lactulose monotherapy, (iii) lactitol monotherapy, (iv) neomycin monotherapy, (v) rifaximin monotherapy and (vi) up\u2010front lactulose with crossover to rifaximin if poor response or intolerance of lactulose (\u2018rifaximin salvage\u2019). The primary outcome was cost per quality\u2010adjusted life\u2010year gained.<\/jats:p><jats:p><jats:bold>Results\u2002<\/jats:bold>Under base\u2010case conditions, \u2018do nothing\u2019 was least effective and rifaximin salvage was most effective. Lactulose monotherapy was least expensive, and rifaximin monotherapy was most expensive. When balancing cost and effectiveness, lactulose monotherapy and rifaximin salvage dominated alternative strategies. Compared to lactulose monotherapy, rifaximin salvage cost an incremental US$2315 per quality\u2010adjusted life\u2010year\u2010gained. The cost of rifaximin had to fall below US$1.03\/tab in order for rifaximin monotherapy to dominate lactulose monotherapy.<\/jats:p><jats:p><jats:bold>Conclusions\u2002<\/jats:bold>Rifaximin monotherapy is not cost\u2010effective in the treatment of chronic hepatic encephalopathy at current average wholesale prices. However, a hybrid salvage strategy, reserving rifaximin for lactulose\u2010refractory patients, may be highly cost\u2010effective.<\/jats:p>","DOI":"10.1111\/j.1365-2036.2007.03464.x","type":"journal-article","created":{"date-parts":[[2010,7,23]],"date-time":"2010-07-23T12:10:44Z","timestamp":1279887044000},"page":"1147-1161","source":"Crossref","is-referenced-by-count":59,"title":["The cost\u2010effectiveness and budget impact of competing therapies in hepatic encephalopathy \u2013 a decision analysis"],"prefix":"10.1111","volume":"26","author":[{"given":"E.","family":"HUANG","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E.","family":"ESRAILIAN","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B. M. 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