Albumin utilization evaluation in a major teaching hospital in Iran: Recommendations for guideline development

Abstract

Objective:Human albumin solution is an expensive colloidal preparation which is commonly used in clinical practice. Due to high cost of albumin, increased rate of the inappropriate use worldwide, and many other reasons, it is imperative to establish a practical protocol to use albumin products and limit its usage. The aim of this study was to identify albumin utilization patterns in a teaching hospital and to demonstrate the importance of the need to reconsider prescribing strategies for albumin administration.Methods:This retrospective cross-sectional study was performed between August 2016 and December 2016 at Firoozgar Hospital affiliated to Iran University of Medical Sciences, Tehran, Iran. All albumin prescriptions for adult patients during the study period were enrolled for appropriateness evaluation according to the latest evidence-based studies and guidelines.Findings:Among 320 albumin prescriptions, 168 (52.5%) were inappropriate according to the current evidence. The most common irrational causes for the albumin usage were hypoalbuminemia (23.4%), nutritional support (13.7%), neuroprotection in subarachnoid hemorrhage (3%), pretreatment for cancer surgery (2.8%), edema (1.6%), hepatic failure (1.6%), and paracentesis (3%). The total amount of albumin used for 320 patients was 52,050 g, from which 28,470 g was inappropriate resulting in $97,398 wastage.Conclusion:These findings, along with aforementioned guidelines, support the requirement for physicians' educational programs and proper strategies for appropriate prescriptions and could also be important in modifying the available guidelines concerning expensive drugs such as albumin.

Prescribers’ Compliance to Human Serum Albumin Usage Criteria and Its Implication on Cost Saving

“…This may be a result of differences in the patient population, disease epidemiology, types of hospitals investigated in various studies. Interestingly, the rate of the appropriate use of HSA in our study was higher compared to previous studies (9–65%) (Aramwit & Kasettratat, 2004; Farsad et al, 2016; Farasatinasab et al, 2018; Foroughinia & Mazraie, 2017; Jahangard-Rafsanjani et al, 2011; Nejad et al, 2010; Shafiee et al, 2016; Talasaz et al, 2012; Tanzi et al, 2003; Torbic et al, 2020). This may partly be a result of differences in usage criteria from our study that differed from criteria of other studies.…”

“…This may partly be a result of differences in usage criteria from our study that differed from criteria of other studies. Criteria used in other studies were derived from clinical practice guideline (Dastan et al, 2018; Foroughinia & Mazraie, 2017; Farsad et al, 2016; Farasatinasab et al, 2018; Jahangard-Rafsanjani et al, 2011; Nejad et al, 2010; Shafiee et al, 2016; Torbic et al, 2020), primary literature (Dastan et al, 2018; Jahangard-Rafsanjani et al, 2011; Nejad et al, 2010; Torbic et al, 2020), AHFS drug information (Aramwit & Kasettratat, 2004; Talasaz et al, 2012) or institutional guideline (Buckley et al, 2021; Tanzi et al, 2003) at the time when those studies were conducted. For our study, due to the limited resources, we placed emphasis on indications where HSA’s roles were well substantiated with clinical evidence and where justification of use can objectively and easily be measured.…”

“…The paucity of solid evidence of HSA in many diseases led to an ambiguous pattern of HSA usage in practice. Several studies investigating HSA utilisation reported varying degrees of appropriateness in HSA usage (Aramwit & Kasettratat, 2004; Foroughinia & Mazraie, 2017; Farsad et al, 2016; Farasatinasab et al, 2018; Jahangard-Rafsanjani et al, 2011; Nejad et al, 2010; Shafiee et al, 2016; Talasaz et al, 2012; Tanzi et al, 2003; Torbic et al, 2020). This may partly derive from the different criteria used to define ‘appropriateness’ in each study.…”