AIM: To determine the most cost-effective hemofiltration modality for early management of severe acute pancreatitis (SAP) in China.METHODS: We carried out a search of Pub-Medline and Chinese Biomedical Disk database. Controlled clinical trials on Chinese population were included in the analysis. The four decision branches that were analyzed were: continuous or long-term veno-venous hemofiltration (CWH/LWH), short-term veno-venous hemofiltration (SWH), SWH plus peritoneal dialysis (PD), and non-hemofiltration control group. The effectiveness of the technique was determined by survival rate, complications prevention and surgery preservation. The total cost of hospitalization was also assessed.RESULTS: The SWH only technique was the least costly modality, $5809 (44449 RMB), and was selected as the baseline treatment modality. SWH only arm achieved the lowest C/E ratio in terms of overall survival, complications prevention and surgery preservation. In incremental cost-effectiveness analysis, the CWH/ LVVH only and the control arms were inferior to other techniques. Sensitivity analysis showed SWH only and SWH plus PD arms overlapped in C/survival ratio.CONCLUSION: The role of early veno-venous hemofiltration as an altative therapy for SAP remains controversial. However, we propose that early use of short-term high-volume veno-venous hemofiltration would have a beneficial impact on the management of SAP.