The cost-effectiveness of albumin in the treatment of decompensated cirrhosis in Germany, Italy, and Spain
Abstract Background Albumin is frequently prescribed in cirrhotic patients with acute decompensation. However, the true cost effectiveness of albumin use in cirrhotic patients is still under debate. Objective To evaluate the cost-effectiveness of albumin in the treatment of decompensated cirrhosis i...
Main Authors: | , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
BMC
2019-07-01
|
Series: | Health Economics Review |
Subjects: | |
Online Access: | http://link.springer.com/article/10.1186/s13561-019-0237-7 |
id |
doaj-fe1ff77c335845f48e1d05236435b0fa |
---|---|
record_format |
Article |
spelling |
doaj-fe1ff77c335845f48e1d05236435b0fa2020-11-25T03:07:32ZengBMCHealth Economics Review2191-19912019-07-019111010.1186/s13561-019-0237-7The cost-effectiveness of albumin in the treatment of decompensated cirrhosis in Germany, Italy, and SpainM. Chris Runken0Paolo Caraceni1Javier Fernandez2Alexander Zipprich3Rashad Carlton4Martin Bunke5Grifols Shared Services North America (SSNA), Inc.Department of Medical and Surgical Sciences, Alma Mater Studiorum University of BolognaLiver ICU, Liver Unit, Hospital Clinic, University of BarcelonaDepartment of Internal Medicine I, Martin-Luther-University Halle-WittenbergXcenda L.L.CSenior Director Medical Affairs, RetrophinAbstract Background Albumin is frequently prescribed in cirrhotic patients with acute decompensation. However, the true cost effectiveness of albumin use in cirrhotic patients is still under debate. Objective To evaluate the cost-effectiveness of albumin in the treatment of decompensated cirrhosis in Germany, Italy, and Spain. Methods A decision-tree economic model was developed to evaluate treatments for decompensated cirrhosis from the hospital perspective over a typical inpatient admission. The treatments for large volume paracentesis (LVP) were albumin vs saline, gelatin, or no fluid. The treatments for spontaneous bacterial peritonitis (SBP) were albumin plus antibiotics vs antibiotics alone. The treatments for hepatorenal syndrome (HRS) were albumin plus a vasoconstrictor vs a vasoconstrictor alone. Effectiveness inputs were literature-based. Cost inputs included pharmacy costs and medical complication costs of decompensated cirrhosis. The primary model assessments were incremental cost-effectiveness ratios (ICERs) per life saved and per quality-adjusted life-year (QALY). Results Albumin was found to be both less costly and more effective relative to saline, gelatin, and no fluid for the treatment of LVP across all 3 countries. For SBP, albumin plus antibiotics was more clinically effective than antibiotics alone in all 3 countries. The combination of albumin plus antibiotics was less costly than antibiotics alone in Germany and Italy, making albumin a dominant treatment (ie, less costly and more effective). In the management of SBP in Spain, albumin plus antibiotics compared to antibiotics alone resulted in ICERs of €1516 per life saved and €3369 per QALY gained. Albumin plus a vasoconstrictor was both less costly and more effective than vasoconstrictor alone in the treatment of HRS across all 3 countries. Conclusion This analysis demonstrates that albumin is cost-effective in terms of lives saved and QALYs gained in the management of decompensated cirrhosis associated with LVP, SBP, or HRS.http://link.springer.com/article/10.1186/s13561-019-0237-7AlbuminDecompensated cirrhosisCost-effectiveness |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
M. Chris Runken Paolo Caraceni Javier Fernandez Alexander Zipprich Rashad Carlton Martin Bunke |
spellingShingle |
M. Chris Runken Paolo Caraceni Javier Fernandez Alexander Zipprich Rashad Carlton Martin Bunke The cost-effectiveness of albumin in the treatment of decompensated cirrhosis in Germany, Italy, and Spain Health Economics Review Albumin Decompensated cirrhosis Cost-effectiveness |
author_facet |
M. Chris Runken Paolo Caraceni Javier Fernandez Alexander Zipprich Rashad Carlton Martin Bunke |
author_sort |
M. Chris Runken |
title |
The cost-effectiveness of albumin in the treatment of decompensated cirrhosis in Germany, Italy, and Spain |
title_short |
The cost-effectiveness of albumin in the treatment of decompensated cirrhosis in Germany, Italy, and Spain |
title_full |
The cost-effectiveness of albumin in the treatment of decompensated cirrhosis in Germany, Italy, and Spain |
title_fullStr |
The cost-effectiveness of albumin in the treatment of decompensated cirrhosis in Germany, Italy, and Spain |
title_full_unstemmed |
The cost-effectiveness of albumin in the treatment of decompensated cirrhosis in Germany, Italy, and Spain |
title_sort |
cost-effectiveness of albumin in the treatment of decompensated cirrhosis in germany, italy, and spain |
publisher |
BMC |
series |
Health Economics Review |
issn |
2191-1991 |
publishDate |
2019-07-01 |
description |
Abstract Background Albumin is frequently prescribed in cirrhotic patients with acute decompensation. However, the true cost effectiveness of albumin use in cirrhotic patients is still under debate. Objective To evaluate the cost-effectiveness of albumin in the treatment of decompensated cirrhosis in Germany, Italy, and Spain. Methods A decision-tree economic model was developed to evaluate treatments for decompensated cirrhosis from the hospital perspective over a typical inpatient admission. The treatments for large volume paracentesis (LVP) were albumin vs saline, gelatin, or no fluid. The treatments for spontaneous bacterial peritonitis (SBP) were albumin plus antibiotics vs antibiotics alone. The treatments for hepatorenal syndrome (HRS) were albumin plus a vasoconstrictor vs a vasoconstrictor alone. Effectiveness inputs were literature-based. Cost inputs included pharmacy costs and medical complication costs of decompensated cirrhosis. The primary model assessments were incremental cost-effectiveness ratios (ICERs) per life saved and per quality-adjusted life-year (QALY). Results Albumin was found to be both less costly and more effective relative to saline, gelatin, and no fluid for the treatment of LVP across all 3 countries. For SBP, albumin plus antibiotics was more clinically effective than antibiotics alone in all 3 countries. The combination of albumin plus antibiotics was less costly than antibiotics alone in Germany and Italy, making albumin a dominant treatment (ie, less costly and more effective). In the management of SBP in Spain, albumin plus antibiotics compared to antibiotics alone resulted in ICERs of €1516 per life saved and €3369 per QALY gained. Albumin plus a vasoconstrictor was both less costly and more effective than vasoconstrictor alone in the treatment of HRS across all 3 countries. Conclusion This analysis demonstrates that albumin is cost-effective in terms of lives saved and QALYs gained in the management of decompensated cirrhosis associated with LVP, SBP, or HRS. |
topic |
Albumin Decompensated cirrhosis Cost-effectiveness |
url |
http://link.springer.com/article/10.1186/s13561-019-0237-7 |
work_keys_str_mv |
AT mchrisrunken thecosteffectivenessofalbumininthetreatmentofdecompensatedcirrhosisingermanyitalyandspain AT paolocaraceni thecosteffectivenessofalbumininthetreatmentofdecompensatedcirrhosisingermanyitalyandspain AT javierfernandez thecosteffectivenessofalbumininthetreatmentofdecompensatedcirrhosisingermanyitalyandspain AT alexanderzipprich thecosteffectivenessofalbumininthetreatmentofdecompensatedcirrhosisingermanyitalyandspain AT rashadcarlton thecosteffectivenessofalbumininthetreatmentofdecompensatedcirrhosisingermanyitalyandspain AT martinbunke thecosteffectivenessofalbumininthetreatmentofdecompensatedcirrhosisingermanyitalyandspain AT mchrisrunken costeffectivenessofalbumininthetreatmentofdecompensatedcirrhosisingermanyitalyandspain AT paolocaraceni costeffectivenessofalbumininthetreatmentofdecompensatedcirrhosisingermanyitalyandspain AT javierfernandez costeffectivenessofalbumininthetreatmentofdecompensatedcirrhosisingermanyitalyandspain AT alexanderzipprich costeffectivenessofalbumininthetreatmentofdecompensatedcirrhosisingermanyitalyandspain AT rashadcarlton costeffectivenessofalbumininthetreatmentofdecompensatedcirrhosisingermanyitalyandspain AT martinbunke costeffectivenessofalbumininthetreatmentofdecompensatedcirrhosisingermanyitalyandspain |
_version_ |
1724669904062251008 |