Which strategy is best for treating hepatic encephalopathy in patients with dementia?

In the management of hepatic encephalopathy among patients diagnosed with dementia, the combination of Fibrosis-4 (FIB-4) screening, hepatology referral, and lactulose therapy provides balance in terms of value and clinical benefit, suggests a study.

This combination helps avoid unnecessary overtreatment while capturing reversible hepatic encephalopathy, according to the authors.

Using a decision-analytic model from a societal perspective, the authors assessed the cost-effectiveness of screening and treatment strategies for hepatic encephalopathy in patients with dementia. They used a decision tree model to compare seven strategies over 1 year.

Six intervention strategies (ie, FIB-4 plus empiric lactulose, FIB-4 plus empiric rifaximin, FIB-4 plus hepatology consult plus lactulose, FIB-4 plus hepatology consult plus rifaximin, empiric lactulose for all, and empiric rifaximin for all) were compared with status quo.

Of the six strategies, five demonstrated higher effectiveness at lower cost compared with status quo, with savings from $6,160 to $13,236. The most cost-efficient strategy was FIB-4 screening followed by hepatology consultation and targeted lactulose therapy, which generated cost savings and a gain in outcomes relative to no screening.

The robustness of screening strategies was confirmed in sensitivity analyses. The results were mostly influenced by treatment response, utility values, and cirrhosis prevalence.

“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,” the authors said.