Human albumin: cost–benefits
Survival and discharge Crystalloid
pDeadSep Survival and discharge Albumin
pDeadAlb ICU fluid therapy in sepsis Renal
Survival at 90 days
Survival and discharge
pDeadHES Figure 3: Decision tree for assessing choice of fluid therapies14
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
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 pharmaco- economic outcomes show that the additional cost of fluid, irrespective of its nature, has no effect on outcome.14
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
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12. Dellinger RP et al. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 2013;41(1):580–637.
13. Guidet B, Mosqueda GJ, Priol G, Aegerter P. The COASST study: cost-effectiveness of albumin in severe sepsis and septic shock. J Crit Care 2007;22(3):197–203.
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15. Should hospital pharmacy drug budgets be the responsibility of each individual department in an institution, or should such budgets be controlled centrally by the pharmacy department? Can J Hosp Pharm 2010;63(4):330–2.
Death at 90 days
pDeadHES90 pRenalHES Bleeding pBleedingHES
Bleeding No bleeding
pBleedingHES No bleeding
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