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.
World J Gastroenterol. 2010 May 14;16(18):2227-34. doi: 10.3748/wjg.v16.i18.2227.
To determine the short-term cost-utility of molecular adsorbent recirculating system (MARS) treatment in acute liver failure (ALF).
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.
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.
MARS treatment combined with standard medical treatment for ALF in an ICU setting is more cost-effective than standard medical treatment alone.
确定分子吸附再循环系统（MARS）治疗急性肝衰竭（ALF）的短期成本效益。
对 2001 年至 2005 年期间接受 MARS 治疗的 90 例 ALF 患者进行了一项对照回顾性研究。并与同一专门治疗肝脏疾病的重症监护病房（ICU）中 2000 年至 2001 年期间接受治疗的 17 例 ALF 患者的历史对照组进行了比较。记录了 3 年的结果和肝移植的数量。对 31 例 MARS 患者和 16 例对照组患者在 ICU 治疗前 6 个月至 3 年后的所有直接与肝脏疾病相关的医疗费用进行了确定。由一组 ICU 医生在 MARS 治疗前和治疗后使用邮寄的 15D（15 维通用健康相关生活质量工具）问卷评估健康相关生活质量（HRQoL）。将 HRQoL、成本和生存数据合并，计算增量成本/质量调整生命年（QALYs）。
在幸存的 ALF 患者中，治疗后的健康相关生活质量通常较高，与年龄和性别匹配的芬兰一般人群相当。与对照组相比，在 3.5 年内，MARS 组的平均每 QALY 成本明显较低（64732 欧元对 133858 欧元）。与 MARS 相比，标准治疗的增量成本为 10928 欧元，MARS 增加的 QALY 为 0.66。
在 ICU 环境中，MARS 治疗与标准治疗联合用于 ALF 比单独使用标准治疗更具成本效益。
