Cirrhosis Clinical Trial
— ARIAPUMPOfficial title:
Medical-economic Evaluation of the Care of Refractory Ascites by Implantation of Alfapump® Device in Cirrhotic Patients
The hypothesis is that the Alfapump® strategy would be more effective in terms of QALYs generated , and that the cost of Alfapump® device and its implantation will be totally or partially offset by the reduction in the number of evacuating parentheses performed and the reduction in the number of complications in patients with refractory ascites awaiting liver transplantation or not. On the other hand, given the difference in the clinical profiles of these two populations (whether or not they are awaiting transplantation), these two populations will be study separately Evaluation of the medical-economic impact at 1 year of the two therapeutic strategies: implantation of Alfapump® versus repeated evacuating paracentesis in cirrhotic patients with refractory ascites without scheduled liver transplantation.
Status | Recruiting |
Enrollment | 90 |
Est. completion date | December 31, 2025 |
Est. primary completion date | December 31, 2022 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: - Patient with refractory ascites who has had a minimum of 5 paracentesis in the last 3 months. - Patient with an estimated life expectancy of at least 6 months on the day of inclusion. - Patient with contraindication to the application of a TIPS or who has expressed a refusal of the procedure or a non-functional TIPS - Patient affiliated with or in receipt of social security - Informed and written consent signed by the patient. Exclusion Criteria: - Local or systemic infection in the month preceding the procedure - Hepatocellular carcinoma with palliative care - MELD Score > 18 - Child Pugh C Score > 10 - Creatinine Clearance < 50 ml/mn - Digestive hemorrhage or episode of hepatic encephalopathy within two weeks prior to device insertion - Contraindication to general anesthesia - Contraindication to implant surgery of the device: - Obstructive urological impairment - Partitioning of ascites - Coagulopathy - Persons referred to in Articles L1121-5 to L1121-8 of the CSP (corresponding to all protected persons: pregnant woman, parturient, breastfeeding mother, person deprived of liberty by judicial or administrative decision, person subject to a legal protection measure). - Patient currently participating in other clinical research or who participated in a clinical trial within one month prior to inclusion. |
Country | Name | City | State |
---|---|---|---|
France | Amiens-Picardie University Hospital | Amiens | |
France | Chu Angers | Angers | |
France | Jean MINJOZ Univesity Hospital | Besançon | |
France | Haut-Lévêque Hospital | Bordeaux | |
France | Beaujon Hospital | Clichy la garenne | |
France | Grenoble University Hospital | Grenoble | |
France | LA PITIE SALPETRIERE Univesity Hospital | Paris | |
France | Chu Pontchaillou | Rennes | |
France | Toulouse University Hospital | Toulouse |
Lead Sponsor | Collaborator |
---|---|
University Hospital, Grenoble |
France,
Bellot P, Welker MW, Soriano G, von Schaewen M, Appenrodt B, Wiest R, Whittaker S, Tzonev R, Handshiev S, Verslype C, Moench C, Zeuzem S, Sauerbruch T, Guarner C, Schott E, Johnson N, Petrov A, Katzarov K, Nevens F, Zapater P, Such J. Automated low flow pump system for the treatment of refractory ascites: a multi-center safety and efficacy study. J Hepatol. 2013 May;58(5):922-7. doi: 10.1016/j.jhep.2012.12.020. Epub 2013 Jan 11. — View Citation
Bureau C, Adebayo D, Chalret de Rieu M, Elkrief L, Valla D, Peck-Radosavljevic M, McCune A, Vargas V, Simon-Talero M, Cordoba J, Angeli P, Rosi S, MacDonald S, Malago M, Stepanova M, Younossi ZM, Trepte C, Watson R, Borisenko O, Sun S, Inhaber N, Jalan R. Alfapump® system vs. large volume paracentesis for refractory ascites: A multicenter randomized controlled study. J Hepatol. 2017 Nov;67(5):940-949. doi: 10.1016/j.jhep.2017.06.010. Epub 2017 Jun 21. Erratum in: J Hepatol. 2018 Jan 29;:. J Hepatol. 2020 Mar;72(3):595-596. — View Citation
Solà E, Solé C, Ginès P. Management of uninfected and infected ascites in cirrhosis. Liver Int. 2016 Jan;36 Suppl 1:109-15. doi: 10.1111/liv.13015. Review. — View Citation
Stepanova M, Nader F, Bureau C, Adebayo D, Elkrief L, Valla D, Peck-Radosavljevic M, McCune A, Vargas V, Simon-Talero M, Cordoba J, Angeli P, Rossi S, MacDonald S, Capel J, Jalan R, Younossi ZM. Patients with refractory ascites treated with alfapump® system have better health-related quality of life as compared to those treated with large volume paracentesis: the results of a multicenter randomized controlled study. Qual Life Res. 2018 Jun;27(6):1513-1520. doi: 10.1007/s11136-018-1813-8. Epub 2018 Feb 19. — View Citation
Stirnimann G, Berg T, Spahr L, Zeuzem S, McPherson S, Lammert F, Storni F, Banz V, Babatz J, Vargas V, Geier A, Stallmach A, Engelmann C, Trepte C, Capel J, De Gottardi A. Treatment of refractory ascites with an automated low-flow ascites pump in patients with cirrhosis. Aliment Pharmacol Ther. 2017 Nov;46(10):981-991. doi: 10.1111/apt.14331. Epub 2017 Sep 21. — View Citation
Thomas MN, Sauter GH, Gerbes AL, Stangl M, Schiergens TS, Angele M, Werner J, Guba M. Automated low flow pump system for the treatment of refractory ascites: a single-center experience. Langenbecks Arch Surg. 2015 Dec;400(8):979-83. doi: 10.1007/s00423-015-1356-1. Epub 2015 Nov 13. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Evaluation of medical-economic impact at 1 year of 2 strategies: implantation of Alfapump® device versus repeated evacuating paracentesis (reference treatment) in cirrhotic patients with refractory ascites without programmed liver transplantation. | Incremental cost-utility ratio (ICER) from societal perspective. | 1 year | |
Secondary | Comparison of the clinical impact at 6 and 12 months of Alfapump® versus repeated evacuating paracentesis in cirrhotic patients with refractory ascites WITHOUT programmed liver transplantation. | Evaluation of the paracentesis-free survival, cirrhosis and device-related adverse events. | 6 months and 1 year | |
Secondary | Evaluation of the clinical impact at 6 and 12 months of Alfapump® versus repeated evacuating paracentesis in cirrhotic patients with refractory ascites WITH programmed liver transplantation. | Evaluation of the paracentesis-free survival, cirrhosis and device-related adverse events. | 6 months and 1 year | |
Secondary | Evaluation of the economic impact at 6 and 12 months of Alfapump® versus repeated evacuating paracentesis in cirrhotic patients with refractory ascites WITH programmed liver transplantation. | Incremental cost-utility ratio. | 6 months and 1 year | |
Secondary | Evaluation of the clinical impact at 2 years of Alfapump® versus repeated evacuating paracentesis (prospective observational study). | Evaluation of paracentesis-free survival, cirrhosis and device-related adverse events. We will analyse separately patients WITH and WITHOUT programmed liver transplantation. | 2 years | |
Secondary | Evaluation of the economic impact at 2 years of Alfapump® versus repeated evacuating paracentesis (prospective observational study). | Incremental cost-utility ratio. We will analyse separately patients WITH and WITHOUT programmed liver transplantation. | 2 years | |
Secondary | Budget impact Analysis from the point of view of French health insurance, at 3 and 5 years. | Economic consequences of the introduction of the AlfapumpĀ® device in the management strategies of cirrhotic patients presenting a refractory ascites. | 3 and 5 years |
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