Abstract
BackgroundAcute-on-chronic liver failure (ACLF) is a life threatening acute decompensation of a pre-existing chronic liver disease. The artificial liver support system MARS is a new emerging therapeutic option possible to be implemented in routine care of these patients. The medical efficacy of MARS has been demonstrated in first clinical studies, but economic aspects have so far not been investigated. Objective of this study was to estimate the cost-effectiveness of MARS.MethodsIn a clinical cohort trial with a prospective follow-up of 3 years 33 ACLF-patients treated with MARS were compared to 46 controls. Survival, health-related quality of life as well as direct medical costs for in- and outpatient treatment from a health care system perspective were determined. Based on the differences in outcome and indirect costs the cost-effectiveness of MARS expressed as incremental costs per life year gained and incremental costs per QALY gained was estimated.ResultsThe average initial intervention costs for MARS were 14600 EUR per patient treated. Direct medical costs over 3 years follow up were overall 40000 EUR per patient treated with MARS respectively 12700 EUR in controls. The 3 year survival rate after MARS was 52% compared to 17% in controls. Kaplan-Meier analysis of cumulated survival probability showed a highly significant difference in favour of MARS. Incremental costs per life-year gained were 31400 EUR; incremental costs per QALY gained were 47200 EUR.ConclusionThe results after 3 years follow-up of the first economic evaluation study of MARS based on empirical patient data are presented. Although high initial treatment costs for MARS occur the significantly better survival seen in this study led to reasonable costs per live year gained. Further randomized controlled trials investigating the medical efficacy and the cost-effectiveness are recommended.
Highlights
Acute-on-chronic liver failure (ACLF) is a life threatening acute decompensation of a pre-existing chronic liver disease
Characteristic complications of ACLF are the development of a renal dysfunction and a multiorgan failure, arterial hypotension, disseminated intravascular coagulation or a disorder of microcirculation leading to damage of extrahepatic organs
Overall 79 patients with an alcohol-induced ACLF could be identified according to the described inclusion and exclusion criteria. 33 of these patients were treated with Molecular Adsorbent Recirculating System (MARS); the other 46 patients were not treated with an artificial liver support system and defined as control group
Summary
Acute-on-chronic liver failure (ACLF) is a life threatening acute decompensation of a pre-existing chronic liver disease. The artificial liver support system MARS is a new emerging therapeutic option possible to be implemented in routine care of these patients. Objective of this study was to estimate the cost-effectiveness of MARS. Acute-on-chronic liver failure (ACLF) is a sudden, severe, life-threatening deterioration of the liver function in patients with a chronic pre-existing liver disease. The prevalence of chronic liver disease in Germany is estimated to lie between 0.5 and 1%[1]. The most frequent underlying reason for ACLF is an irreversible liver damage due to chronic alcohol abuse, followed by viral hepatitis (e.g. HBV, HCV) and autoimmune disorders[2]. The 30dmortality of patients with ACLF is high[2], but the liver has a potential to regenerate. If the patients survive the first crucial weeks of the acute decompensation the 5-year survival rate is relatively high
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
