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Human albumin: cost–benefits


The role of albumin in cirrhosis has also been examined for its cost–benefit9 in a study demonstrating the usefulness of using such analyses in identifying sub- groups 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


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 use of these


approaches will assist the assessment of albumin in the therapeutic armamentarium.


Figure 2: Publicity material for a HES product, 2011. Withdrawn because of misleading claims after request by the US FDA


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 molecular structure of albumin


"Even supposedly objective and clinical evidence- based processes like the Cochrane Collaboration cannot help including comments on costs in their reports"


22


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


www.hospitalpharmacyeurope.com


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


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 interventions13


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


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