The Cost-effectiveness of albumin in the treatment of decompensated cirrhosis in Italy, Spain and Germany

Con: The Unclear Benefit of Albumin

“…The primary reason for the lack of statistical significance appears to stem from the inclusion of 2 studies in the former analysis but not the latter as the authors disagreed as to whether these were appropriate . A recent health economic assessment presented in an abstract has suggested that the use of albumin for LVP, SBP, or HRS was cost‐effective in both survival and quality‐adjusted life‐years across Italy, Spain, and Germany . However, only in the LVP model was albumin compared with another fluid.…”

“…(26) A recent health economic assessment presented in an abstract has suggested that the use of albumin for LVP, SBP, or HRS was cost-effective in both survival and quality-adjusted life-years across Italy, Spain, and Germany. (27) However, only in the LVP model was albumin compared with another fluid.…”

“…(12) The MACHT authors detected suppression, but not normalization, of renin-angiotensin-aldosterone system activity, and perhaps a greater dose of albumin or longer duration of treatment is required to benefit patients. The forthcoming Effects of Long-Term Administration of Human Albumin in Subjects With Decompensated Cirrhosis and Ascites (PRECICIOSA) trial (27) in which the treatment arm will receive 1.5 g/kg body weight of albumin every 10 ± 2 days may clarify this. However, neither ANSWER nor PRECICIOSA are blinded placebo-controlled trials, and therefore, the control groups have no fluid or weekly medical care, which introduces an inherent bias in intensity of medical supervision.…”