Jia Chen,1,* Qiumin Luo,1,* Lu Wang,2,* Lihua Zheng,1 Yeqiong Zhang,1 Ying Liu,1 Liang Peng,1,3 Wenxiong Xu1 

1Department of Infectious Diseases and Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China; 2Department of Diagnostics, second School of Clinical Medicine, Binzhou Medical University, Yantai, Shandong, People’s Republic of China; 3Key Laboratory of Tropical Disease Control, Ministry of Education, Sun Yat-sen University, Guangzhou, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Wenxiong Xu, Department of Infectious Disease, Third Affiliated Hospital of Sun Yat-sen University, 600# Tianhe Road, Tianhe District, Guangzhou, Guangdong province, 510630, People’s Republic of China, Tel +8613760783281, Email xuwenx@mail.sysu.edu.cn Liang Peng, Department of Infectious Disease, Third Affiliated Hospital of Sun Yat-sen University, 600# Tianhe Road, Tianhe District, Guangzhou, Guangdong province, 510630, People’s Republic of China, Tel +8613533978874, Email pliang@mail.sysu.edu.cn

Purpose: This study aimed to compare the cost-effectiveness of the double plasma molecular adsorption system sequential low-volume plasma exchange (DPMAS+LPE) versus conventional plasma exchange (PE) in treating early-stage hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF).
Patients and Methods: A total of 215 early-stage HBV-ACLF patients were assigned to either DPMAS+LPE or conventional PE groups. After propensity score matching (1:1), 101 matched pairs were analyzed. We compared 30- and 90-day survival rates and direct medical costs from the healthcare payer’s perspective. Cost-effectiveness analysis was performed with a willingness-to-pay (WTP) threshold of $12,681 and $38,043, equivalent to 1 and 3 times China’s 2023 per capita GDP. Univariate and probabilistic sensitivity analyses (Bootstrap method) were used to assess parameter uncertainty.
Results: Over the 90-day follow-up period, the DPMAS+LPE group had numerically higher survival rates compared to the PE group, but this difference was not statistically significant (91.04% vs 83.07%, Logrank: P=0.094). Compared to PE, DPMAS+LPE showed no economic benefit at 30 days. At 90 days, each 1% increase in the survival rate with DPMAS+LPE required an additional $3013.68 in medical costs, demonstrating cost-effectiveness. In the cirrhosis subgroup, the 90-day average total medical cost of the DPMAS+LPE group was lower than that of the PE group. At a WTP threshold of $12,681, the probability of DPMAS+LPE being cost-effective was 14% at 30 days and 75% at 90 days. At a WTP of $38,043, these probabilities increased to 45% and 90%, respectively. Univariate sensitivity analysis demonstrated that variations in the 90-day survival rates and costs for both groups still favored DPMAS+LPE within the 95% confidence interval. However, when the number of DPMAS+LPE treatments exceeded 4.4, it was no longer cost-effective.
Conclusion: Compared to PE, DPMAS+LPE demonstrated cost-effectiveness at 90 days in early-stage HBV-ACLF patients, particularly those with cirrhosis. While DPMAS+LPE can be considered a suitable artificial liver therapy option for early-stage HBV-ACLF, careful consideration must be given to the number of treatments to ensure cost-effectiveness.

Keywords: acute-on-chronic liver failure, double plasma molecular adsorption system, plasma exchange, economic evaluation