Efficacy and Economic Evaluation of Nonbiological Artificial Liver Therapy in Acute-on-chronic Hepatitis B Liver Failure

Background and Aims:Nonbiological artificial liver(NBAL)is frequently used as a first-line treatment for hepatitis B virus-associated acute-on-chronic liver failure(HBV-ACLF).This study aimed to compare the therapeutic efficacy and cost-effectiveness ratio(CER)of comprehensive medical treatment,plasma exchange(PE),and double plasma molecular adsorption system(DPMAS)plus half-dose PE(DPMAS+PE)in patients with HBV-ACLF.Methods:A total of 186 patients with HBV-ACLF randomly received comprehensive medical treatment,PE,or DPMAS+PE and were prospectively evaluated.Patients were divided into four subgroups based on the pretreatment prothrombin activity(PTA):Group I(PTA>40%),group II(PTA 30–40%),group III(PTA 20–30%),and group IV(PTA<20%).The main outcome measures were 28 day effectiveness;90 day liver transplantation-free survival;change of biochemical parameters;and CER.Results:DPMAS+PE treatment was associated with significantly higher 28 day effectiveness and 90 day liver transplantation-free survival compared with PE treatment in patients with group I liver failure.Clearance of serum total bilirubin(TBIL),AST,and creatinine(Cr)were significantly higher in the DPMAS+PE group than in the PE group.For subjects with group I liver failure,DPMAS+PE treatment had advantages of lower CER values and better cost-effectiveness.Conclusions:Compared with comprehensive medical treatment and PE alone,DPMAS with halfdose sequential PE treatment more effectively improved TBIL,AST,and Cr in HBV-ACLF patients,improved 28 day effectiveness and 90 day survival rates in patients with group I liver failure,and was more cost effective.DPMAS+PE is a viable NBAL approach for treatment of HBV-ACLF.