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Cost Effectiveness and Resource Allocation
Published in: Cost Effectiveness and Resource Allocation 1/2006

Open Access 01-12-2006 | Research

Economic evaluation of the artificial liver support system MARS in patients with acute-on-chronic liver failure

Author: Franz P Hessel

Published in: Cost Effectiveness and Resource Allocation | Issue 1/2006

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Abstract

Background

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. 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.

Methods

In 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.

Results

The 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.

Conclusion

The 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.
Appendix
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Literature
1.
Boker KH: [Acute liver failure]. Internist (Berl) 2001,42(4):545–54, 556–62.CrossRef
2.
Lee WM: Acute liver failure in the United States. Semin Liver Dis 2003,23(3):217–226. 10.1055/s-2003-42641PubMedCrossRef
3.
Bauer M, Winning J, Kortgen A: Liver failure. Curr Opin Anaesthesiol 2005,18(2):111–116. 10.1097/01.aco.0000162827.74270.32PubMedCrossRef
4.
Sen S, Williams R, Jalan R: Emerging indications for albumin dialysis. Am J Gastroenterol 2005,100(2):468–475. 10.1111/j.1572-0241.2005.40864.xPubMedCrossRef
5.
Stange J, Hassanein TI, Mehta R, Mitzner SR, Bartlett RH: The molecular adsorbents recycling system as a liver support system based on albumin dialysis: a summary of preclinical investigations, prospective, randomized, controlled clinical trial, and clinical experience from 19 centers. Artif Organs 2002,26(2):103–110. 10.1046/j.1525-1594.2002.06822.xPubMedCrossRef
6.
Stange J, Mitzner SR, Risler T, Erley CM, Lauchart W, Goehl H, Klammt S, Peszynski P, Freytag J, Hickstein H, Lohr M, Liebe S, Schareck W, Hopt UT, Schmidt R: Molecular adsorbent recycling system (MARS): clinical results of a new membrane-based blood purification system for bioartificial liver support. Artif Organs 1999,23(4):319–330. 10.1046/j.1525-1594.1999.06122.xPubMedCrossRef
7.
Steiner C, Mitzner S: Experiences with MARS liver support therapy in liver failure: analysis of 176 patients of the International MARS Registry. Liver 2002, 22 Suppl 2: 20–25.PubMed
8.
Mitzner S, Klammt S, Stange J, Noldge-Schomburg GF, Schmidt R: [Extracorporeal blood purification in severe liver failure with the albumin dialysis MARS -- impact on relevant intensive care parameters]. Anasthesiol Intensivmed Notfallmed Schmerzther 2005,40(4):199–206. 10.1055/s-2004-826116PubMedCrossRef
9.
Jalan R, Sen S, Steiner C, Kapoor D, Alisa A, Williams R: Extracorporeal liver support with molecular adsorbents recirculating system in patients with severe acute alcoholic hepatitis. J Hepatol 2003,38(1):24–31. 10.1016/S0168-8278(02)00334-3PubMedCrossRef
10.
Hessel FP: Reimbursement of high-prized new emerging Medical Devices in a DRG-based Hospital Care System – The German Situation. Expert Reviews in Pharmacoeconomics and Outcomes Research 2005, 5: 377–381. 10.1586/14737167.5.4.377CrossRef
11.
Heemann U, Treichel U, Loock J, Philipp T, Gerken G, Malago M, Klammt S, Loehr M, Liebe S, Mitzner S, Schmidt R, Stange J: Albumin dialysis in cirrhosis with superimposed acute liver injury: a prospective, controlled study. Hepatology 2002,36(4 Pt 1):949–958.PubMedCrossRef
12.
Mitzner SR, Stange J, Klammt S, Risler T, Erley CM, Bader BD, Berger ED, Lauchart W, Peszynski P, Freytag J, Hickstein H, Loock J, Lohr JM, Liebe S, Emmrich J, Korten G, Schmidt R: Improvement of hepatorenal syndrome with extracorporeal albumin dialysis MARS: results of a prospective, randomized, controlled clinical trial. Liver Transpl 2000,6(3):277–286. 10.1053/lv.2000.6355PubMedCrossRef
13.
Hessel FP, Mitzner SR, Rief J, Gress S, Guellstorff B, Wasem J: Economic evaluation of MARS--preliminary results on survival and quality of life. Liver 2002, 22 Suppl 2: 26–29.PubMedCrossRef
14.
Hessel FP, Mitzner SR, Rief J, Guellstorff B, Steiner S, Wasem J: Economic evaluation and 1-year survival analysis of MARS in patients with alcoholic liver disease. Liver Int 2003, 23 Suppl 3: 66–72.PubMedCrossRef
15.
Krauth C, Hessel F, Hansmeier T, Wasem J, Seitz R, Schweikert B: [Empirical standard costs for health economic evaluation in Germany -- a proposal by the working group methods in health economic evaluation]. Gesundheitswesen 2005,67(10):736–746. 10.1055/s-2005-858698PubMedCrossRef
16.
Glennie JL, Torrance GW, Baladi JF, Berka C, Hubbard E, Menon D, Otten N, Riviere M: The revised Canadian Guidelines for the Economic Evaluation of Pharmaceuticals. Pharmacoeconomics 1999,15(5):459–468. 10.2165/00019053-199915050-00004PubMedCrossRef
17.
Gold MR, Siegel JE, Russell LB, Weinstein MC: Cost-effectiveness in Health and Medicine. Oxford University Press, Oxford 1996.
18.
CCOHTA: A Guidance Document for the costing process. CCOHTA, Ottawa 1996.
19.
CCOHTA: Guidelines for economic evaluation of pharmaceuticals: Canada 2nd ed. CCOHTA, Ottawa 1997.
20.
21.
Liu JP, Gluud LL, Als-Nielsen B, Gluud C: Artificial and bioartificial support systems for liver failure. Cochrane Database Syst Rev 2004, CD003628.
22.
23.
Hirth RA, Chernew ME, Miller E, Fendrick AM, Weissert WG: Willingness to pay for a quality-adjusted life year: in search of a standard. Med Decis Making 2000,20(3):332–342.PubMedCrossRef
24.
Khuroo MS, Khuroo MS, Farahat KL: Molecular adsorbent recirculating system for acute and acute-on-chronic liver failure: a meta-analysis. Liver Transpl 2004,10(9):1099–1106. 10.1002/lt.20139PubMedCrossRef
Metadata
Title
Economic evaluation of the artificial liver support system MARS in patients with acute-on-chronic liver failure
Author
Franz P Hessel
Publication date
01-12-2006
Publisher
BioMed Central
Published in
Cost Effectiveness and Resource Allocation / Issue 1/2006
Electronic ISSN: 1478-7547
DOI
https://doi.org/10.1186/1478-7547-4-16

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