{
  "abstract": "Introduction Acute-on-chronic liver failure (ACLF) is a syndrome of acute decompensation of cirrhosis characterised by multi-organ failure (MOF) and high mortality. There are no specific treatments for ACLF, but several agents are in clinical trials. However, approvals for widespread use (e.g. by the National Institute for Health and Care Excellence, NICE) will require determination of cost-effectiveness. There are currently limited data defining the costs of standard-of-care treatment for ACLF, making economic evaluation and calculation of incremental cost-effectiveness ratios (ICERs) for emerging therapies challenging. The aim of this study was to calculate the cost of ACLF treatment in the intensive care (ICU) setting, to provide a standard-of-care cost for future health economic analyses.Methods Retrospective data were collected from consecutive patients with ACLF admitted to Royal Free London ICU between February 2017 and January 2021. Each admission episode was analysed separately; elective ICU admissions were excluded. Costs were calculated based on days of organ support received, total length of hospital admission, and investigations performed; standard costs were applied using 2024 NHS National Cost Collection data. Kruskal-Wallis Test was used for non-parametric continuous data, and Mann-Whitney U Test for comparison of costs between survivors and non-survivors.Results Ninety-three consecutive admissions were analysed (mean age 52.9 years; male: n=65, female: n=28; ACLF G1: n=15, G2: n=31, G3: n=47). The median total cost (including ICU and non-ICU stay) was £33,195.20. Median daily cost was £2,273.33 for ICU stay alone and £1,302.09 when averaged across the entire hospital admission. Total costs increased with grade of ACLF: median daily cost G1: £925.52, G2: £1,231.06, G3: £1,609.65; p<0.001. Median daily costs were also significantly greater for ICU non-survivors (survivors, n=67: £1,188.37 vs non-survivors, n=26: £2,367.17; p<0.001). Figure 1 shows total costs per day for ACLF patients, separated by ACLF grade and survival. One outlier >3xIQR (£7,467.33, G3 non-survivor) is omitted from the graph, but included in all analyses.Conclusions These results define contemporary standard-of-care costs for ACLF managed in critical care. The data may support health-economic modelling of interventional ACLF trials, and inform strategies to address key cost drivers, while optimising patient outcomes and hospital resource use.Abstract P105 Figure 1",
  "authors": [
    {
      "affiliations": [
        "University College London, London, United Kingdom"
      ],
      "name": "Alisa Okazaki"
    },
    {
      "affiliations": [
        "Princess Srisavangavadhana College of Medicine Chulabhorn Royal Academy, Bangkok, Thailand"
      ],
      "name": "Pimpitcha Lertkiatdamrong"
    },
    {
      "affiliations": [
        "King’s College Hospital NHS Foundation Trust, London, United Kingdom"
      ],
      "name": "Thomas Dixon"
    },
    {
      "affiliations": [
        "University College London, London, United Kingdom",
        "Royal Free London NHS Foundation Trust, London, United Kingdom"
      ],
      "name": "Rohit Saha"
    },
    {
      "affiliations": [
        "Royal Free London NHS Foundation Trust, London, United Kingdom"
      ],
      "name": "Sherif Ghabina"
    },
    {
      "affiliations": [
        "University College London, London, United Kingdom",
        "Royal Free London NHS Foundation Trust, London, United Kingdom"
      ],
      "name": "Banwari Agarwal"
    },
    {
      "affiliations": [
        "University College London, London, United Kingdom",
        "Royal Free London NHS Foundation Trust, London, United Kingdom"
      ],
      "name": "Gautam Mehta"
    }
  ],
  "title": "P105 The health economic cost of acute-on-chronic liver failure: a tertiary centre evaluation",
  "uid": "ed080808-feb5-5020-b8d5-c34c89a282c8"
}