Cost-utility of molecular adsorbent recirculating system treatment in acute liver failure.
OBJECTIVE
To determine the short-term cost-utility of molecular adsorbent recirculating system (MARS) treatment in acute liver failure (ALF).


METHODS
A controlled retrospective study was conducted with 90 ALF patients treated with MARS from 2001 to 2005. Comparisons were made with a historical control group of 17 ALF patients treated from 2000 to 2001 in the same intensive care unit (ICU) specializing in liver diseases. The 3-year outcomes and number of liver transplantations were recorded. All direct liver disease-related medical expenses from 6 mo before to 3 years after ICU treatment were determined for 31 MARS patients and 16 control patients. The health-related quality of life (HRQoL) before MARS treatment was estimated by a panel of ICU doctors and after MARS using a mailed 15D (15-dimensional generic health-related quality of life instrument) questionnaire. The HRQoL, cost, and survival data were combined and the incremental cost/quality-adjusted life years (QALYs) was calculated.


RESULTS
In surviving ALF patients, the health-related quality of life after treatment was generally high and comparable to the age- and gender-matched general Finnish population. Compared to the controls, the average cost per QALY was considerably lower in the MARS group (64,732 euros vs 133,858 euros) within a timeframe of 3.5 years. The incremental cost of standard medical treatment alone compared to MARS was 10,928 euros, and the incremental number of QALYs gained by MARS was 0.66.


CONCLUSIONS
MARS treatment combined with standard medical treatment for ALF in an ICU setting is more cost-effective than standard medical treatment alone.
Kantola
Taru
T
Department of Anesthesiology and Intensive Care Medicine, Surgical Hospital of Helsinki, Helsinki University Hospital, Kasarminkatu 11-13, PO Box 263, FIN-0029 HUCH, Helsinki, Finland. taru.kantola@hus.fi
Mäklin
Suvi
S
Koivusalo
Anna-Maria
AM
Räsänen
Pirjo
P
Rissanen
Anne
A
Roine
Risto
R
Sintonen
Harri
H
Höckerstedt
Krister
K
Isoniemi
Helena
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D017114:Liver Failure, Acute / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D016060:Sorption Detoxification / Q000191:economics* / Q000379:methods; D055815:Young Adult
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