Significance of prognostic prediction and cost-benefit-analysis in intensive therapy in fulminant hepatitis

We reviewed the clinieal records of 12 patients with fulminant hepatitis, who were hospitalized in the last 3 yeres in our institution, focusing on the gross medical cost, re-evalution of the prognostic prediction and several social problems associated with the treatment. All of the eight patients with subacute fulminant hepatitis by non-A non-B non-C type hepatitis virus infection died. The prognostic prediction by the logistic analysis proposed by Takahashi et al. and by the proposed guideline for the liver transplantation agree with the acutual prognosis in all cases. The gross medical expense spent for three patinets who had been treated in the ICU for more than 60 days, but died of liver failure lastly was high (23, 300, 000, 14, 700, 000 and 20, 270, 000 yen for the respective case). The cost per day exceed 40, 000 yen in 5 patients (42%) during treatment for an averaged of 15 days. Therefore, medical expenses of about 10, 000, 000yen per month are needed for the treatment of a patient with fulminant hepatitis in the ICU. We concluded that patients with subacute fulminant hepatitis who was predicted the death should immediately received liver transplantation and should justify the choice of best treatment with fully acceptable explanation about the treatment and with informed consent of patient and family.