P2411 - Financial Burden of Drugs Prescribed for Cirrhosis-Associated Symptoms

Ujas Patel, MD¹, Kshitij Thakur, MD, MSc¹, Bhumi Patel, PharmD², Kishore Karri, MD¹, Alla Grigorian, MD, PhD^1
1University of Kentucky, Lexington, KY; ²Walmart, Lexington, KY

Introduction: Symptomatic burden of decompensated cirrhosis has a progressive trajectory as the condition advances. As health declines, the financial burden from symptomatic medications can be profound. Well-rounded gastroenterologists and other clinicians should know the costs of these medications and the alternatives that may be available to maximize possible savings for patients living with a high financial toxicity condition. We present the costs of commonly used drugs for symptom management in a patient with decompensated cirrhosis in two counties in the state of Kentucky.

Methods: We reviewed the AASLD practice guidelines and compiled a composite list of four of the most common decompensated cirrhosis symptoms and medications used for relief of each symptom. These include hepatic encephalopathy (HE), ascites, muscle cramps, and pruritus. Due to its complex nature and various management options, we excluded pain from this study. The GoodRx website/smartphone application were used to identify both the average retail price (ARP) and the lowest discounted price (LDP, i.e. the cheapest out of pocket option) for anticipated one month supply of medications at competing pharmacies in Fayette county (urban) and Harlan county (rural) in Kentucky.

Results: For management of HE, lactulose carried an ARP of $48.16 in the urban county as opposed to $72.5 in the rural county. However, when LDP is taken into consideration, the costs were similar (i.e., $17.5 in urban county and $16.49 in rural). Rifaximin carried the most out-of-pocket expense with ARP of $3713 vs. $3810 in the urban and rural county, respectively. For ascites, the cheapest option was furosemide in both counties at $4 due to the availability of Walmart and its $4 list of medications. The ARP for ascites management ranged from $6.94 for furosemide to $122 for eplerenone in Fayette County as opposed to $4.02 for furosemide to $136 for eplerenone in Harlan County. For pruritus, the ARP was $89.95 in Fayette County and $102 in Harlan County. LDP was again relatively similar in the two counties: $31.89 vs $33.97.

Discussion: Symptom management in decompensated cirrhosis can carry a high average retail price out-of-pocket monthly cost for the patient in both urban and rural areas. Awareness of the GoodRx discount tool for the uninsured or underinsured patient and their clinicians can help guide selection of cost-effective medication for management.


Disclosures:


Ujas Patel, MD¹, Kshitij Thakur, MD, MSc¹, Bhumi Patel, PharmD², Kishore Karri, MD¹, Alla Grigorian, MD, PhD¹. P2411 - Financial Burden of Drugs Prescribed for Cirrhosis-Associated Symptoms, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.