title: Overt hepatic encephalopathy in Italy: clinical outcomes and healthcare costs.
abstract: OBJECTIVE
  Hepatic encephalopathy (HE) is a recurrent severe complication of progressive hepatic cirrhosis. The aim of this study is to evaluate the average annual direct healthcare costs for the treatment of patients with overt HE in Italy.
  
  
  METHODS
  This retrospective, observational study analyzed information from the database of ARNO Observatory. Patients with at least one hospitalization due to overt HE in the period from January 1, 2011 to December 31, 2011, were selected and observed during the year following the hospitalization. Costs for drugs, diagnostic and therapeutic procedures, and hospitalizations were estimated from the Italian National Health Service perspective.
  
  
  RESULTS
  Out of a population of 2,678,462 subjects, 381 patients were identified, of whom, 21.5% died during the first hospitalization and 5.8% during the follow-up; the survival rate was 72.7% at the end of the observation period. The direct healthcare costs per patient amounted to €13,393/year (15,295 USD) (88% for hospitalizations, 8% for drugs, and 4% for diagnostic procedures). During the follow-up, 42.5% of patients had at least one rehospitalization due to HE. Patients readmitted for HE had an average annual cost of €21,272 (24,293 USD), almost doubled if compared to patients without readmissions (€12,098 [13,816 USD]).
  
  
  CONCLUSIONS
  This analysis showed that patients with HE had relevant direct healthcare costs, in which hospitalizations were the most important cost drivers.
authors.affiliation: ProCure Solutions, Nembro, Bergamo, Italy.
authors.forename: Daniela Paola
authors.initials: DP
authors.lastname: Roggeri
authors.affiliation: ProCure Solutions, Nembro, Bergamo, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Roggeri
authors.affiliation: CINECA, Interuniversity Consortium, Bologna, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Rossi
authors.affiliation: CINECA, Interuniversity Consortium, Bologna, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Cinconze
authors.affiliation: Catholic University of Sacred Heart, Policlinic A Gemelli, Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Gasbarrini
authors.affiliation: Alfa Wassermann, Bologna, Italy.
authors.forename: PierAlessandro
authors.initials: P
authors.lastname: Monici Preti
authors.affiliation: CINECA, Interuniversity Consortium, Bologna, Italy.
authors.forename: Marisa
authors.initials: M
authors.lastname: De Rosa
keywords: costs; hepatic encephalopathy; hospitalizations; relapses