Economic evaluation and 1-year survival analysis of MARS in patients with alcoholic liver disease.
Objective of this study was to determine 1-year survival, costs and cost-effectiveness of the artificial liver support system Molecular Adsorbent Recirculating System (MARS) in patients with acute-on-chronic liver failure (ACLF) and an underlying alcoholic liver disease. In a case-control study, 13 patients treated with MARS were compared to 23 controls of similar age, sex and severity of disease. Inpatient hospital costs data were extracted from patients' files and hospital's internal costing. Patients and treating GPs were contacted, thus determining resource use and survival 1-year after treatment. Mean 1-year survival time in MARS group was 261 days and 148 days in controls. Kaplan-Meier analysis shows advantages of MARS patients (Logrank: P=0.057). Direct medical costs per patient for initial hospital stay and 1-year follow-up from a payer's perspective were Euro 18,792 for MARS patients and Euro 9638 for controls. The costs per life-year gained are Euro 29,719 (time horizon 1 year). From a societal perspective, the numbers are higher (costs per life-year gained: Euro 79,075), mainly because of the fact that there is no regular reimbursement of MARS and therefore intervention costs were not calculated from payer's perspective. A trade-off between medical benefit and higher costs has to be made, but 1-year results suggest an acceptable cost-effectiveness of MARS. Prolonging the time horizon and including indirect costs, which will be done in future research, would probably improve cost-effectiveness.
Hessel
Franz P
FP
Institute for Health Care Management, University of Essen, Germany. franz.hessel@uni-essen.de
Mitzner
Steffen R
SR
Rief
Jana
J
Guellstorff
Britta
B
Steiner
Susanne
S
Wasem
Jürgen
J
D000328:Adult; D016022:Case-Control Studies; D003362:Cost-Benefit Analysis; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D005102:Health Expenditures / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D008108:Liver Diseases, Alcoholic / Q000191:economics* / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D006435:Renal Dialysis / Q000191:economics* / Q000401:mortality; D012189:Retrospective Studies; D016060:Sorption Detoxification / Q000191:economics* / Q000401:mortality; D016019:Survival Analysis