Cost-effectiveness of the artificial liver support system MARS in patients with acute-on-chronic liver failure.
BACKGROUND
For patients with an acute exacerbation of chronic liver failure (ACLF), the molecular adsorbent recirculating system (MARS) can result in a prolongation of life, but data on costs and cost-effectiveness are lacking.


METHODS
A health economic evaluation of a prospective controlled cohort trial in patients with ACLF not eligible for liver transplantation with 3 years follow-up and consecutive modelling of long-term costs, outcomes and cost-effectiveness was conducted. Costs were calculated from the perspective of the German health-care system.


RESULTS
One hundred and forty-nine patients with ACLF were included of which 67 (44.9%) were treated with MARS and 82 (55.1%) assigned to the control group. Mean survival was 692 days in MARS-treated patients (33% survival after 3 years) and 453 days in control patients (15% after 3 years, logrank P = 0.022). MARS patients gained 0.66 [95% confidence interval (CI): -0.12 to 1.46] life years (LYs), determined by the bootstrap method. The mean cost difference was 19.835 euro (95% CI: 13.308-25.429) with 35639 euro for MARS-treated patients and 15804 euro for controls. Incremental costs per LY gained were 29.985 euro (95% CI: 9.441-321.761) and 43.040 euro (95% CI: 13.551-461.856) per quality-adjusted LY gained.


CONCLUSIONS
There is an acceptable cost-effectiveness of MARS, compared with other medical technologies presently reimbursed. Randomized controlled trials with sufficient sample size are necessary before a final recommendation for MARS can be given.
Institute for Health Care Management, University of Duisburg-Essen, Essen D-45127, Germany. franz.hessel@uni-due.de
Franz P
FP
Hessel
Peter
P
Bramlage
Jürgen
J
Wasem
Steffen R
SR
Mitzner
D000328:Adult; D000418:Albumins / Q000008:administration & dosage*; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D005260:Female; D005858:Germany; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D016018:Least-Squares Analysis; D017114:Liver Failure, Acute / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D019164:Liver, Artificial / Q000191:economics*; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009010:Monte Carlo Method; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment; D016060:Sorption Detoxification / Q000191:economics*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
D000418:Albumins