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©2010 Baishideng. All rights reserved
Cost-utility of molecular adsorbent recirculating system treatment in acute liver failure
Taru Kantola, Suvi Mäklin, Anna-Maria Koivusalo, Pirjo Räsänen, Anne Rissanen, Risto Roine, Harri Sintonen, Krister Höckerstedt, Helena Isoniemi
Taru Kantola, Anna-Maria Koivusalo, Department of Anesthesiology and Intensive Care Medicine, Surgical Hospital of Helsinki, Helsinki University Hospital, PO Box 263, FIN-00029 HUCH, Helsinki, Finland
Suvi Mäklin, Pirjo Räsänen, Finnish Office for Health Technology Assessment at the National Institute for Health and Welfare, PO Box 30, FI-00271 Helsinki, Finland
Anne Rissanen, Risto Roine, Helsinki and Uusimaa Hospital Group, Group Administration, PO Box 705, 00029 HUS, Helsinki, Finland
Harri Sintonen, Department of Health Economics, University of Helsinki, Department of Public Health and Finnish Office for Health Technology Assessment, PO Box 41, 00014 University of Helsinki, Helsinki, Finland
Krister Höckerstedt, Department of Surgery, Transplantation and Liver Surgery Clinic, Helsinki University Hospital, PO Box 263, FIN-00029 HUCH, Helsinki, Finland
Helena Isoniemi, Transplantation and Liver Surgery Clinic, Helsinki University Hospital, PO Box 263, FIN-00029 HUCH, Helsinki, Finland
Author contributions: All authors designed the research; Kantola T, Koivusalo AM, Rissanen A, Mäklin S and Rissanen A performed the research; Sintonen H and Roine R provided the analytical tools applied in the study; Kantola T, Mäklin S and Räsänen P analyzed the data; Kantola T and Mäklin S wrote the paper.
Supported by Scientific grants from the Helsinki University Central Hospital Research Fund (EVO) and the Finnish Office for Health Technology Assessment
Correspondence to: Dr. Taru Kantola, MD, 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
Telephone: +358-9-4711 Fax: +358-9-654294
Received: December 23, 2009
Revised: January 27, 2010
Accepted: February 4, 2010
Published online: May 14, 2010
AIM: 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 treatmeant 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€vs 133 858€) within a timeframe of 3.5 years. The incremental cost of standard medical treatment alone compared to MARS was 10 928€, and the incremental number of QALYs gained by MARS was 0.66.
CONCLUSION: MARS treatment combined with standard medical treatment for ALF in an ICU setting is more cost-effective than standard medical treatment alone.
