Will Health Insurers Cover the Costs?

The Diagnosis and Treatment of Minimal Hepatic Encephalopathy by Dr. med. Tianzuo Zhan, Prof. Dr. med. Dr. h.c. med. Wolfgang Stremmel in volume 10/2012

The authors of the review article recommended treatment with lactulose and rifaximine 550 mg twice daily for three to six months. This raises the question of how this recommendation—administration of a nonabsorbable antibiotic—is to be implemented into practice. Theoretically, the daily treatment costs for rifaximin 1100 mg amount to a minimum of 15 euros, which translates into about 2700 euros for six months. Rifaximin is currently not licensed for this indication, and doctors can therefore not prescribe it. Will the health insurers cover these costs?

It was not mentioned whether rifaximin was tested against another substance (antibiotic) as placebo.

For clinically practicing physicians, it is of importance that any therapeutic recommendation is easy in implementation and suitable for 2012. The authors should mention which established antibiotic treatment is recommended alternatively.

Additionally there might be readers who would like to know whether the authors themselves prescribe rifaximin for their patients.

DOI: 10.3238/arztebl.2012.0502b

Dr. med. Klaus Muehlenberg

Krankenhaus Barmherzige Brüder Regensburg

Conflict of interest statement

The author declares that no conflict of interest exists.

References

1. Zhan T, Stremmel W: The diagnosis and treatment of minimal hepatic encephalopathy. Dtsch Arztebl Int 2012; 109(10): 180–7.