different diseases , 10 the use of these approaches will assist the assessment of albumin in the therapeutic armamentarium .
Albumin in sepsis Severe sepsis is a clinical syndrome , originating in the systemic inflammatory response following infection , which is a major cause of hospital mortality and a considerable economic burden . 11 Resuscitation in sepsis is initially based on fluid therapy , through guidelines that now specify albumin as the treatment of choice following first line resuscitation . 12 Despite the clinical evidence and the relative harms of alternative therapies , it is important to subject albumin ’ s role in this condition to pharmacoeconomic assessment . A previous study addressed the scenario utilising the data from the SAFE study for a population of French ICU patients , and found that , in this hypothetical case , albumin usage in sepsis led to favourable cost-effectiveness outcomes relative to other funded interventions 13 but did not examine the important issue of alternative therapies . The availability of commercial decision analysis software for conducting such work has facilitated the conduct of cost-effectiveness analysis of competing treatments .
A cost-effectiveness analysis comparing the three alternative fluids – albumin , crystalloid and HES – was therefore performed using data from the literature and other public information for costs . A preliminary report has been published . 14 The relevant decision tree outlining the choices available and the path through which the patient population was taken is shown in Figure 2 . The model predicted that albumin treatment leads to an increased life gain of 0.22 life years relative to crystalloid fluid
A model predicted that albumin treatment leads to an increased life gain of 0.22 life years relative to crystalloid fluid treatment for sepsis treatment for sepsis , while treatment with HES leads to a loss of 1.00 life years . The calculated cost of $ 9149 per life year gained with albumin is well within the range of measures considered cost effective by reimbursement agencies . Added attractions to this approach include the ability to analyse the effect of variables such as age on the outcomes . Further research on sepsis including the effect of quality of life on cost-effectiveness outcomes may also be informed by models such as these . The key issue is that these analyses are more sophisticated than ‘ bottle to bottle ’ comparisons and give payers the opportunity to assess the effect of therapeutic choice on total medical costs . The risk of developing budgets to small areas within hospitals includes the temptation to ignore global , long-term benefits to healthcare for patients and focus on the immediate need to cut costs regardless of ultimate outcomes . 15 The introduction of approaches such as the one described is therefore highly desirable .
Albumin in cardiac surgery Cardiac surgery frequently requires fluid replacement intra- and perioperatively . 16 Albumin is used widely for this purpose and in coronary artery by grafting ( CABG ), its administration resulted in a 25 % reduction in postoperative mortality , compared to synthetic colloids . 17 Acute kidney injury is a major problem in hospital interventions . 18 Notably , a randomised , controlled trial of albumin administration for a serum albumin level of less than 4.0g / dl prior to off-pump coronary artery bypass surgery resulted in a significant decrease in stage 1 acute kidney injury in patients given albumin . 19 The cost-effectiveness of this intervention is not yet fully established , as the study did
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