Human albumin (HA) is currently recommended by the European Association for the Study of the Liver for the management of hypovolaemia associated with complications of decompensated cirrhosis, but its use has been questioned owing to its high cost.
A theoretical cost-effectiveness analysis from the hospitals’ perspective in Germany, Italy, and Spain revealed that HA combined with antibiotics vs. antibiotics alone resulted in lower mortality (22% vs. 41%) and higher quality-adjusted life-years (QALYs) gained (0.351 vs. 0.266) for patients with spontaneous bacterial peritonitis.
The combination was less costly in Germany (13,598 vs. 15,268 EUR) and Italy (6969 vs. 7058 EUR), whereas it resulted in a cost-effectiveness ratio of 1516 EUR per life saved and 3369 EUR per QALY gained in Spain.
For patients with hepatorenal syndrome, the use of HA with vasoconstrictors was associated with increased QALYs gained, and lower mortality and costs vs. vasoconstrictors alone in the three countries evaluated.
This was also observed in cases requiring large-volume paracentesis, where HA treatment was more effective and less expensive than saline, gelatin, or no fluid, due to lower costs incurred with complications and lower mortality.
Overall, use of HA results in lower total costs and improved clinical outcomes compared with other fluids.