Analysis of the Cost-Effectiveness of Treatment Strategies for Acute-on-Chronic Liver Failure.

OBJECTIVE

This study aimed to evaluate the cost-effectiveness of 3 artificial liver models, plasma exchange (PE), the double plasma molecular absorption system (DPMAS), and a combination of plasma exchange with the double plasma molecular absorption system (PE + DPMAS) as well as medical drugs in treating patients with acute-on-chronic liver failure.

METHODS

A retrospective approach was employed to collect clinical data from electronic medical records. The study included 296 patients who met the inclusion criteria and were categorized based on their treatment into 2 groups: the medical treatment group and the artificial liver group, the latter of which included PE, DPMAS, and PE + DPMAS. To compare the costs and effectiveness of the medical treatment group with the 3 artificial liver treatment groups, a pharmacoeconomic cost-effectiveness analysis was conducted to assess the economic aspects.

RESULTS

The effectiveness rate of the PE + DPMAS group was 76.9%, which was significantly higher than that of the PE and DPMAS group (P < .05). The effectiveness rate of the PE group was similar to that of the DPMAS group (P > .05). The effectiveness rate in all 3 artificial liver treatment groups was higher than that of the medical treatment group (P < .05). The total cost per person was RMB 54,661.6, RMB 61,385.5, RMB 71,789.2, and RMB 65,945.7 in the medical treatment, and the artificial liver PE group, DPMAS, and PE + DPMAS groups, respectively. The cost-effectiveness ratio (C/E) was 2009.6, 1162.6, 1511.4, and 758.9, respectively. The sensitivity analysis results for costs were consistent with the cost-effectiveness analysis results.

CONCLUSIONS

The artificial liver treatment group demonstrated a superior "performance-cost ratio," with the PE + DPMAS group being the most effective. This combination can be considered the optimal treatment for acute-on-chronic liver failure when combined with appropriate drug therapy.