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Altawalbeh SM, Almestarihi EM, Khasawneh RA, Momany SM, Abu Hammour K, Shawaqfeh MS, Abraham I. Cost-effectiveness of intravenous resuscitation fluids in sepsis patients: a patient-level data analysis in Jordan. J Med Econ 2024; 27:126-133. [PMID: 38105744 DOI: 10.1080/13696998.2023.2296196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/14/2023] [Indexed: 12/19/2023]
Abstract
AIM Albumin role as fluid resuscitation in sepsis remains understudied in low- and middle-income countries. This study aimed to evaluate the cost-effectiveness of intravenous (IV) Albumin compared to Crystalloids in sepsis patients using patient-level data in Jordan. METHODS This was a retrospective cohort study of sepsis patients aged 18 or older admitted to intensive care units (ICU) at two major tertiary hospitals during the period 2018-2019. Patients information, type of IV fluid, and clinical outcomes were retrieved from medical records, and charges were retrieved from the billing system. A 90-day partitioned survival model with two health states (alive and dead) was constructed to estimate the survival of sepsis patients receiving either Albumin or Crystalloids as IV fluids for resuscitation. Overall survival was predicted by fitting a Weibull model on the patient-level data from the current study. To further validate the results, and to support the assessment of uncertainty, time-dependent transition probabilities of death at each cycle were estimated and used to construct a state-transition patient-level simulation model with 10,000 microsimulation trials. Adopting the healthcare system perspective, incremental cost-effectiveness ratios(ICERs) of Albumin versus Crystalloids were calculated in terms of the probability to be discharged alive from the ICU. Uncertainty was explored using probabilistic sensitivity analysis. RESULTS In the partitioned survival model, Albumin was associated with an incremental cost of $1,007 per incremental1% in the probability of being discharged alive from the ICU. In the state-transition patient-level simulation model, ICER was $1,268 per incremental 1% in the probability of being discharged alive. Probabilistic sensitivity analysis showed that Albumin was favored at thresholds >$800 per incremental 1%in the probability of being discharged alive from the ICU. CONCLUSION IV Albumin use in sepsis patients might not be cost-effective from the healthcare perspective of Jordan. This has important implications for policymakers to readdress Albumin prescribing practice in sepsis patients.
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Affiliation(s)
- Shoroq M Altawalbeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Eman M Almestarihi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Rawand A Khasawneh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Suleiman M Momany
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Khawla Abu Hammour
- Department of Biopharmaceutics and Clinical Pharmacy, The University of Jordan, Amman, Jordan
| | - Mohammad S Shawaqfeh
- Department of pharmacy practice, College of pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ivo Abraham
- Center for Health Outcomes and PharmacoEconomic Research, R. Ken Coit College of Pharmacy, University of Arizona, Tucson, AZ, USA
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Altawalbeh SM, Almestarihi EM, Khasawneh RA, Momany SM, Ababneh MA, Shawaqfeh MS. Clinical and economic outcomes associated with intravenous albumin fluid use in the intensive care unit: a retrospective cohort study. Expert Rev Pharmacoecon Outcomes Res 2023; 23:789-796. [PMID: 37191454 DOI: 10.1080/14737167.2023.2215431] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/15/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVES This study was undertaken to evaluate the prescribing practice of albumin in the intensive care unit (ICU) and to compare the clinical and economic outcomes associated with intravenous (IV) albumin compared to crystalloids in the ICU. METHODS This was a retrospective cohort study of ICU adult patients admitted to King Abdullah University Hospital during 2018-2019. Patient demographics, clinical characteristics, and admission charges were retrieved from medical records and billing system. Survival analysis, multivariable regression models, and propensity score matching estimator were performed to evaluate the impact of IV resuscitation fluid types on the clinical and economic outcomes. RESULTS Albumin administration in the ICU was associated with significantly lower hazards of ICU death (HR = 0.57; P value <0.001), but without improving overall death probability compared to crystalloids. Albumin was associated with significant prolongation in the ICU length of stay (5.86 days; P value <0.001). Only 88 patients (24.3%) were prescribed albumin for Food and Drug Administration (FDA)-approved indications. Admission charges were significantly higher for patients treated with albumin (p value <0.001). CONCLUSIONS IV Albumin use in the ICU was not associated with significant improvement in clinical outcomes, but with a remarkable increase in economic burden. The majority of patients received albumin for non-FDA-approved indications.
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Affiliation(s)
- Shoroq M Altawalbeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Eman M Almestarihi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Rawand A Khasawneh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Suleiman Mohammad Momany
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mera A Ababneh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad S Shawaqfeh
- Department of pharmacy practice, College of pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Leili M, Nikvarz N. Evaluating the role of clinical pharmacist in the detection and reduction of medication errors in a specialized burn unit. Burns 2022; 49:646-654. [PMID: 35610074 DOI: 10.1016/j.burns.2022.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 03/20/2022] [Accepted: 04/13/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE This study evaluated the frequency and types of medication errors and the role of clinical pharmacist in the reduction of medication errors in a burn unit. METHODS The clinical pharmacist monitored medication use process in all patients admitted to the burn unit in the 4-month interventional study. Direct observation and chart review methods were used to detect medication errors. Medication errors were classified according to the classification of American Society of Health-system Pharmacists. The seriousness of medication errors was categorized based on the National Coordinating Council for Medication Error Reporting and Prevention index. RESULTS During the study, 1653 drugs were prescribed to 94 patients. Totally, 259 medication errors were identified. The rates of medication errors were 2.75 errors/patient, 0.16 errors/ordered medication, and 0.98 errors/prescription. The most common type of errors was prescribing error (61.8%) followed by dispensing error (14.7%). Regarding the seriousness of medication errors, 1.9%, 21.6%, 45.9%, 30.1%, and 0.4% of errors were in the categories B, C, D, E, and F, respectively. Antibiotics had the highest rate of errors. Of all detected medication errors, 64.5% were intercepted or corrected by the clinical pharmacist interventions. CONCLUSION Medication errors were not rare in the burn unit. Providing clinical pharmacy services to burn patients to reduce the incidence of medication errors is highly recommended.
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Chan RJ, Beaubien-Souligny W, Silver SA, Bagshaw SM, Wald R, Brown PA, Hiremath S, Kong JW, Clark EG. The Use of I.V. Albumin During Kidney Replacement Therapy: A Survey of Nephrologists and Intensivists. Kidney Int Rep 2021; 7:614-617. [PMID: 35257074 PMCID: PMC8897299 DOI: 10.1016/j.ekir.2021.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/25/2021] [Accepted: 11/29/2021] [Indexed: 12/02/2022] Open
Affiliation(s)
- Ryan J. Chan
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - William Beaubien-Souligny
- Division of Nephrology, Department of Medicine, Centre Hospitalier de l’Université de Montréal, Montréal, Quebec, Canada
| | - Samuel A. Silver
- Division of Nephrology, Department of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Sean M. Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ron Wald
- Division of Nephrology, St. Michael’s Hospital (Unity Health), University of Toronto, Toronto, Ontario, Canada
| | - Pierre-Antoine Brown
- Division of Nephrology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
- Kidney Research Centre and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Swapnil Hiremath
- Division of Nephrology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
- Kidney Research Centre and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jennifer W.Y. Kong
- Kidney Research Centre and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Edward G. Clark
- Division of Nephrology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
- Kidney Research Centre and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Correspondence: Edward G. Clark, Division of Nephrology, Department of Medicine, The Ottawa Hospital—Riverside Campus, 1967 Riverside Drive, Ottawa, Ontario K1H 7W9, Canada.
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Hryciw N, Joannidis M, Hiremath S, Callum J, Clark EG. Intravenous Albumin for Mitigating Hypotension and Augmenting Ultrafiltration during Kidney Replacement Therapy. Clin J Am Soc Nephrol 2021; 16:820-828. [PMID: 33115729 PMCID: PMC8259476 DOI: 10.2215/cjn.09670620] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Among its many functions, owing to its oversized effect on colloid oncotic pressure, intravascular albumin helps preserve the effective circulatory volume. Hypoalbuminemia is common in hospitalized patients and is found especially frequently in patients who require KRT either for AKI or as maintenance hemodialysis. In such patients, hypoalbuminemia is strongly associated with morbidity, intradialytic hypotension, and mortality. Intravenous albumin may be administered in an effort to prevent or treat hypotension or to augment fluid removal, but this practice is controversial. Theoretically, intravenous albumin administration might prevent or treat hypotension by promoting plasma refilling in response to ultrafiltration. However, clinical trials have demonstrated that albumin administration is not nearly as effective a volume expander as might be assumed according to its oncotic properties. Although intravenous albumin is generally considered to be safe, it is also very expensive. In addition, there are potential risks to using it to prevent or treat intradialytic hypotension. Some recent studies have suggested that hyperoncotic albumin solutions may precipitate or worsen AKI in patients with sepsis or shock; however, the overall evidence supporting this effect is weak. In this review, we explore the theoretical benefits and risks of using intravenous albumin to mitigate intradialytic hypotension and/or enhance ultrafiltration and summarize the current evidence relating to this practice. This includes studies relevant to its use in patients on maintenance hemodialysis and critically ill patients with AKI who require KRT in the intensive care unit. Despite evidence of its frequent use and high costs, at present, there are minimal data that support the routine use of intravenous albumin during KRT. As such, adequately powered trials to evaluate the efficacy of intravenous albumin in this setting are clearly needed.
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Affiliation(s)
- Nicole Hryciw
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Swapnil Hiremath
- Division of Nephrology, Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jeannie Callum
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Edward G. Clark
- Division of Nephrology, Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Otero TMN, Aljure OD, Yu S. Postoperative resuscitation with hypertonic saline or hyperoncotic albumin in patients following cardiac surgery: A review of the literature. J Card Surg 2020; 36:1040-1049. [PMID: 33283332 DOI: 10.1111/jocs.15233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/12/2020] [Accepted: 11/11/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Over-resuscitation in postcardiac surgery patients is associated with significant morbidity and mortality. Accordingly, there is a growing interest in hyperoncotic albumin and hypertonic saline for resuscitation in patients following cardiac surgery. In this article, we will review the use of hyperosmolar fluid therapies for resuscitation in postcardiac surgical patients from the current literature. METHODS A literature search was conducted in MEDLINE (PubMed) utilizing keywords, narrowing publications from 2009 to 2020. RESULTS Patients receiving concentrated albumin after cardiac surgery required less fluid bolus therapy, less time on vasopressors, and had a lower positive fluid balance compared with patients receiving crystalloids. There was no difference in mortality in those given 20% albumin compared with crystalloids postcardiac surgery. Patients administered hypertonic saline following cardiac surgery had increased urinary output but its effect on total fluid and body weight was not significantly different compared with crystalloids. CONCLUSIONS In this analysis, publications on resuscitation with hyperoncotic albumin and hypertonic saline in patients following cardiac surgery were reviewed. While there is data supporting the use of alternative fluid therapies in other critically ill populations, the limited literature focused on concentrated albumin and hypertonic saline for resuscitation following cardiac surgery is equivocal.
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Affiliation(s)
- Tiffany M N Otero
- Department of Anesthesiology, Banner University Medical Center, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Oscar D Aljure
- Department of Anesthesiology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Soojie Yu
- Department of Anesthesiology, Banner University Medical Center, University of Arizona College of Medicine, Tucson, Arizona, USA
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