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. 2019 Jan;29(1):869-876.
doi: 10.4314/ejhs.v29i1.8.

Is Albumin-based Resuscitation in Severe Sepsis and Septic Shock Justifiable? An Evidence from a Cost-effectiveness Evaluation

Bereket Tigabu  1   2   3 , Majid Davari  1   2 , Abbas Kebriaeezadeh  1   2 , Mojtaba Mojtahedzadeh  4   5 , Kourosh Sadeghi  4 , Zahra Jahangard-Rafsanjani  4
Affiliations

Is Albumin-based Resuscitation in Severe Sepsis and Septic Shock Justifiable? An Evidence from a Cost-effectiveness Evaluation

Bereket Tigabu et al. Ethiop J Health Sci. 2019 Jan.

Abstract

Background: Fluid and antimicrobial therapy are the essential parts of sepsis management. The type of fluid to resuscitate with is an unsettled issue in the treatment of severe sepsis and septic shock. The objective of this study was to evaluate the cost-effectiveness of albumin-based resuscitation over crystalloids.

Methods: A cost-effectiveness analysis was conducted by extracting data from a database of Sina Hospital, Islamic Republic of Iran. A decision tree was constructed by using Tree Age Pro 2011. The patients were grouped based on the types of fluids used for resuscitation into crystalloid alone or crystalloid + albumin groups at the initial decision node. The patients were followed from the onset of severe sepsis and septic shock upto 28 days. The healthcare payers' perspective was considered in constructing the model. The cost was measured in US dollars and the effectiveness was measured by life years gained.

Results: The addition of albumin during resuscitation of patients with severe sepsis and septic shock has an effectiveness gain of 0.09 life years and cost increment of 495.00 USD. The estimated ICER for this analysis was 5500.00 USD per life year gained. The probability that albumin is cost-effective at one GDP per capita is 49.5%.

Conclusion: Albumin-based resuscitation is not cost-effective in Iran when a GDP per capita was considered for a life year gain. The cost-effectiveness was insensitive to the cost of standard care. We recomend the caustious use albumin as per the Surviving Sepsis Campaign guideline.

Keywords: Albumin; cost-effectiveness; crystalloids; economic; evaluation.

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Figures

Figure 1
Figure 1
Decision tree
Figure 2
Figure 2
Cost-effectiveness acceptability curve
See this image and copyright information in PMC

References

    1. Semler MW, Rice TW. Sepsis Resuscitation: Fluid Choice and Dose. Clinics in chest medicine. 2016;37(2):241. - PMC - PubMed
    1. Sagy M, Al-Qaqaa Y, Kim P. Definitions and pathophysiology of sepsis. Current problems in pediatric and adolescent health care. 2013;43(10):260–263. - PubMed
    1. Howell MD, Davis AM, Management of. sepsis and septic shock. Jama. 2017;317(8):847–848. - PubMed
    1. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive care medicine. 2013;39(2):165. - PMC - PubMed
    1. Silversides JA, Major E, Ferguson AJ, Mann EE, McAuley DF, Marshall JC, et al. Conservative fluid management or deresuscitation for patients with sepsis or acute respiratory distress syndrome following the resuscitation phase of critical illness: a systematic review and meta-analysis. Intensive care medicine. 2017;43(2):155–170. - PubMed

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