Survival and discharge |
Albumin |
In-hospital death
pDeadAlb
|
ICU fluid therapy in sepsis |
Renal pRenalHES |
Bleeding pBleedingHES No bleeding |
Survival at 90 days |
Survival and discharge |
No renal |
Bleeding pBleedingHES
No bleeding
|
HES |
Death at 90 days |
|
In-hospital death
pDeadHES
|
pDeadHES90 |
|
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 .
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
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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 . l
References
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