HPE Human albumin handbook | Page 18

common is allergies , which manifest as nausea , fever , flushing , and urticaria . 35 These symptoms usually disappear after reducing the rate of administration or withdrawal .
International clinical studies did not report any increase in human albumin-related adverse reactions in cirrhotic patients treated with human albumin . 36 , 37 Many clinical studies in China have also found that the incidence of adverse reactions in combined therapy with human albumin and diuretics is lower , 3 , 4 , 6 , 9 and the incidence of complications is lower compared with diuretics alone . 7 , 8 There was no difference in adverse reactions for human albumin compared with mannitol in the treatment of ascites due to cirrhosis . 12
Phamacoeconomics Given the limited access to human albumin and its cost , pharmacoeconomic analysis to evaluate the cost and benefits of human albumin in patients with cirrhosis is warranted . International studies have suggested that 20 % human albumin is more cost-effective than 3.5 % polygeline when treating ascites due to cirrhosis . 38 Another study suggested that long-term use of albumin can reduce a number of decompensated complications . The incremental cost-effectiveness ratio was € 21,265 per qualityadjusted life-years ( QALY ), which was lower than the threshold (€ 35,000 per QALY ) and considered costeffective . 13 However , some researchers pointed out that not all costs had been considered in the above studies , so the results are not definite . 39
Pharmacoeconomic evaluations of human albumin in patients with liver cirrhosis in China have not been conducted so far . However , Chinese researchers have compared the efficacy of different human albumin regimens in HCC patients with cirrhosis after resection , and found that reasonable use of isotonic ( 5 %) and hypertonic ( 25 %) albumin can stabilise blood circulation , perfuse organs more effectively , promote liver function recovery more effectively , shorten the length of hospital stay after surgery , and reduce the use of albumin and plasma compared with the use of hypertonic albumin alone . 40 42 This provides a good basis for the rational application of human albumin .
Conclusions In conclusion , international studies with high evidence are the mainstay in the area of human albumin for the treatment of ascites due to cirrhosis and other related complications at present . For patients with liver cirrhosis in China , published studies showed that patients with ascites can benefit from short-term use of human albumin , and the risk of kidney injury in patients with SBP is decreased . But resources are limited , and the strength of the evidence is weak . At present , there is still a lack of large-scale , multi-centre , high-quality studies on the use of human albumin in Chinese patients with liver cirrhosis , and corresponding high-quality pharmacoeconomic evaluations . In the future , more research is warranted to further clarify whether the use of human albumin in patients with liver cirrhosis in China is beneficial and cost-effective and which population can benefit . High-quality largescale multi-centre studies are required to observe efficacy , safety and cost-effectiveness of the shortand long-term use of human albumin in patients with liver cirrhosis with different characteristics .
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