HPE Human Albumin Update | Page 24

Human albumin : cost – benefits
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Figure 2 : Publicity material for a HES product , 2011 . Withdrawn because of misleading claims after request by the US FDA
The molecular structure of albumin
" Even supposedly objective and clinical evidencebased processes like the Cochrane Collaboration cannot help including comments on costs in their reports "
evidence care . Pharmacoeconomic analysis is one area of health technology assessment ( HTA ) which is increasingly used by healthcare agencies and payers to assist decision making . This kind of decision making is being rapidly devolved to individual hospital departments , particularly pharmacies in the case of drug purchasing . The pressure on these individual areas , each fighting to retain their budgets and provide services , makes them particularly vulnerable to commercial claims regarding the relative costs of treatments . Such claims have included material from the manufacturers of HES , drawing attention to the higher cost of albumin versus HES ( Figure 2 ), and are reflective of earlier analyses comparing the costs of different fluids in areas such as cardiac surgery , where simple ' bottle to bottle ' costs were compared as a basis for suggested choices . 7 A rigorous cost-effectiveness analysis is needed in making such comparisons , in which all costs and outcomes such as morbidity , mortality and length of intensive care stay , for example , can be factored into the final outcome . Some areas of fluid treatment have been subjected to such an exercise , for example , in the area of goal-directed therapy . 8 The role of albumin in cirrhosis has also been examined for its cost – benefit 9 in a study demonstrating the usefulness of using such analyses in identifying subgroups of patients where clinical and cost benefits may be targeted . Given the evolving perspective of albumin as a drug with specific pharmacological effects in different diseases , 10 the use of these approaches will assist the assessment of albumin in the therapeutic armamentarium .
A specific example – 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 3 . The model predicted that albumin treatment leads to an increased life gain of 0.22 life years relative to crystalloid fluid treatment for sepsis , while treatment with HES leads to www . hospitalpharmacyeurope . com