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 (115% 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(sic) (95% CI: 13.308-25.429) with 35639 (sic) for MARS-treated patients and 15804(sic) for controls. Incremental costs per LY gained were 29.985 (sic) (95% CI: 9.441-321.761) and 43.040 (sic) (95% CI: 13.551-461.856) per quality-adjusted LY gained. Conclusion 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. Eur J Gastroenterol Hepatol 22:213-220 (C) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.