HPE Human albumin handbook | Page 30

TABLE 1
Cost – utility analysis
Standard medical treatment
Standard medical treatment + albumin
Total cost / patient / year (€)
7275
9763
Incremental cost / patient / year (€)
2488
QALY gain / year ( QALY )
0.392
0.509
Incremental QALY / year ( QALY )
0.117
Incremental cost-effectiveness ratio (€/ QALY )
21265
not detect differences in expensive parameters such as hospital length of stay , despite the firm establishment of the effect of acute kidney injury on these parameters in other patient populations .
Albumin in liver cirrhosis The use of albumin in hepatology currently represents the best evidence of its use in clinical medicine . 20 Besides clear benefits in enhancing survival and decreasing morbidity , the use of albumin in this area is also cost effective . Patients with cirrhosis treated with 20 % human albumin showed significantly lower liver-related complications compared to those treated with 3.5 % polygeline and , in addition , the median hospital cost for a 30-day period was significantly lower in the albumin group ( 1915 Euros vs . 4612 Euros ). 21
In the recently completed Albumin for the treatmeNt of aScites in patients With hEpatic ciRrhosis ( ANSWER ) study , the unequivocal efficacy of long-term human albumin administration in patients with decompensated cirrhosis was accompanied by demonstrable cost-effectiveness in a conventional cost – utility analysis ( Table 1 ). 22
Conclusions – albumin as the last colloid standing ? Albumin stands centre-stage in the debate over fluid therapies and management costs . This natural colloid would clearly be the therapy of choice if the decision was not obscured by cost issues . Approaching such a decision has to be done in the context of assessing total medical costs , which , in the case of the diseases treated by albumin ( for example , sepsis and cirrhosis ) are high , irrespective of the costs of fluids and the pharmacoeconomic outcomes show that the additional cost of fluid , irrespective of its nature , has no effect on outcome . 14 Hence , this level of decision making has to be taken from the purview of areas where the focus is immediate , short-term , competitive resource management . In the era when other colloids have been shown to be unsafe , albumin has come into its own as a safe , effective therapy with demonstrable cost effectiveness .
References 1 Farrugia A . Albumin usage in clinical medicine : tradition or therapeutic ? Transf Med Rev 2010 ; 24 ( 1 ): 53 – 63 . 2 Reviewers CIGA . Human albumin administration in critically ill patients : systematic review of randomised controlled trials . BMJ 1998 ; 317 ( 7153 ): 235 – 40 . 3 Wise J . Boldt : the great pretender . BMJ 2013 ; 346 : f1738 . 4 Myburgh J , McIntyre L . New insights into fluid resuscitation . Intens Care Med 2013 ; 39 ( 6 ): 998 – 1001 . 5 Farrugia A . Safety of plasma volume expanders . J Clin Pharmacol 2011 ; 51 ( 3 ): 292 – 300 . 6 Bansal M et al . Relative survival benefit and morbidity with fluids in severe sepsis – A network meta-analysis of alternative therapies . Curr Drug Saf 2013 ; 8 ( 4 ): 236 – 45 .
7 Palanzo DA et al . Hetastarch as a prime for cardiopulmonary bypass . Ann Thorac Surg 1982 ; 34 ( 6 ): 680 – 3 . 8 Huang DT et al . Implementation of early goal-directed therapy for evere sepsis and septic shock : A decision analysis . Crit Care Med 2007 ; 35 ( 9 ): 2090 – 100 . 9 Gentilini P et al . Albumin improves the response to diuretics in patients with cirrhosis and ascites : results of a randomized , controlled trial . J Hepatol 1999 ; 30 ( 4 ): 639 – 45 . 10 Evans TW . Review article : albumin as a drug-biological effects of albumin unrelated to oncotic pressure . Aliment Pharmacol Ther 2002 ; 16 Suppl 5:6 – 11 . 11 Burchardi H , Schneider H . Economic aspects of severe sepsis : a review of intensive care unit costs , cost of illness and cost effectiveness of
therapy . Pharmacoeconomics 2004 ; 22 ( 12 ): 793 – 813 . 12 Dellinger RP et al . Surviving Sepsis Campaign : International guidelines for management of severe sepsis and septic shock : 2012 . Crit Care Med 2013 ; 41 ( 1 ): 580 – 637 . 13 Guidet B et al . The COASST study : cost-effectiveness of albumin in severe sepsis and septic shock . J Crit Care 2007 ; 22 ( 3 ): 197 – 203 . 14 Farrugia A , Martin G , Bult M . Colloids for sepsis : Effectiveness and cost issues . Ann Update Crit Care Emer Med 2013 ; 515 – 26 . 15 Bernard K et al . Should hospital pharmacy drug budgets be the responsibility of each individual department in an institution , or should such budgets be controlled centrally by the pharmacy department ? Can J Hosp Pharm 2010 ; 63 ( 4 ): 330 – 2 .
16 Lange M et al . Intravascular volume therapy with colloids in cardiac surgery . J Cardiothorac Vasc Anesth 2011 ; 25 ( 5 ): 847 – 55 . 17 Sedrakyan A et al . Volume expansion with albumin decreases mortality after coronary artery bypass graft surgery . Chest 2003 ; 123 ( 6 ): 1853 – 7 . 18 Chertow GM et al . Acute kidney injury . Mortality , length of stay , and costs in hospitalized patients . JASN 2005 ; 16 ( 11 ): 3365 – 70 . 19 Lee EH et al . Effect of exogenous albumin on the incidence of postoperative acute kidney injury in patients undergoing off-pump coronary artery bypass surgery with a preoperative albumin level of less than 4.0 g / dl . Anesthesiology 2016 ; 124 ( 5 ): 1001 – 11 . 20 Caraceni P et al ; Italian Association for the Study of
the Liver ( AISF ). AISF-SIMTI position paper : the appropriate use of albumin in patients with liver cirrhosis . Blood Transfus 2016 ; 14 ( 1 ): 8 – 22 . 21 Moreau R et al . Comparison of outcome in patients with cirrhosis and ascites following treatment with albumin or a synthetic colloid : a randomised controlled pilot trial . Liver Int 2006 ; 26 ( 1 ): 46 – 54 . 22 Caraceni P et al . Longterm albumin administration in decompensated cirrhosis ( ANSWER ): an open-label randomised trial . Lancet 2018 ; 391 ( 10138 ): 2417 – 29 .
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