While the cost of production for albumin is higher than saline ($133/L compared to $2/L), the actual use of albumin in Australia has not fallen drastically since the SAFE study (36.6% of patients receiving fluid resuscitation received albumin in 2007 compared to 31.6% in 2013). This may be because albumin is provided free-of-charge to public hospitals in Australia. The study has however likely prevented an increase in use of albumin. Eligible participants Primary Outcome Secondary outcomes Clinical context Main clinical assumptions if implemented outcomes Albumin and saline results in equivalent Total adult ICU Death from all Survival time during Enduring controversy on the impact of Cost based on study fluid administered (saline mortality, and mechanical ventilation admissions per year causes at 28 the first 28 days, new resuscitation fluid on patient outcomes. No and albumin) and packed red blood cells. use, renal replacement therapy, length 123,564 days after organ failures, statistically significant difference shown. Use of No cost differences required for process measures of stay in ICU and hospital. There is Proportion of ICU randomisation. mechanical ventilation albumin has remained consistent since the trial, (net fluid balance, heart rate on day 1, central some evidence that trauma patients use, renal possibly indicating a preference for albumin, venous pressure and serum albumin). patients receiving benefit more from resuscitation with replacement therapy which is provided free-of charge at the point of albumin for fluid saline than non-trauma patients, but this and length of ICU and use, to Australian public hospitals., resuscitation = 35% requires further study. hospital stay. N= 42,415 Outcome Difference in risk N if Health service Economic Impact on QALY impact Economic impact on Total Economic Impact between control implemented cost per health service costs if per person QALYS if and treatment at 65% person or day implemented implemented Primary & Secondary No statistically significant difference - - - - - Change in -$16m intervention costs - - Totals -$16m Columns may not sum due to rounding. Negative values are savings in the calculations. Health Health Service or service/outcome Explanation and costing assumptions Reference Outcome cost per person or day
While the cost of production for albumin is higher than saline ($133/L compared to $2/L), the actual use of albumin in Australia has not fallen drastically since the SAFE study (36.6% of patients receiving fluid resuscitation received albumin in 2007 compared to 31.6% in 2013). This may be because albumin is provided free-of-charge to public hospitals in Australia. The study has however likely prevented an increase in use of albumin. Outcome Eligible participants if implemented Primary outcomes Secondary outcomes Clinical context Main clinical assumptions Albumin and saline results in equivalent mortality, and mechanical ventilation use, renal replacement therapy, length of stay in ICU and hospital. There is some evidence that trauma patients benefit more from resuscitation with saline than non-trauma patients, but this requires further study. Total adult ICU admissions per year 123,564 Death from all causes at 28 days after randomisation. Survival time during the first 28 days, new organ failures, mechanical ventilation use, renal replacement therapy and length of ICU and hospital stay. Enduring controversy on the impact of resuscitation fluid on patient outcomes. No statistically significant difference shown. Use of albumin has remained consistent since the trial, possibly indicating a preference for albumin, which is provided free-of charge at the point of use, to Australian public hospitals., Cost based on study fluid administered (saline and albumin) and packed red blood cells. No cost differences required for process measures (net fluid balance, heart rate on day 1, central venous pressure and serum albumin). Proportion of ICU patients receiving albumin for fluid resuscitation = 35% N= 42,415 Outcome Difference in risk between control and treatment N if implemented at 65% Health service cost per person or day Economic Impact on health service costs if implemented QALY impact per person Economic impact on QALYS if implemented Total Economic Impact Primary & Secondary No statistically significant difference - - - - - Change in intervention costs Totals -$16m - - -$16m Columns may not sum due to rounding. Negative values are savings in the calculations. Health Service or Outcome Health service/outcome cost per person or day Explanation and costing assumptions Reference
Supplementary-Appendix-B-Economic-evaluation-of-investigator-initiated-clinical-trials-conducted-by-networks.docx