title: Costs related to inappropriate use of albumin in Spain.
abstract: BACKGROUND
  Albumin has been used in various treatments for > 50 years, but, recently, its use in clinical practice has become very controversial.
  
  
  OBJECTIVE
  To assess the use of albumin in clinical practice in the public hospital setting in Andalucía, Spain, focusing on the economic repercussions of the inappropriate use of albumin.
  
  
  METHODS
  Multicentered observational study in 22 public hospitals in which all patients receiving albumin (from start to conclusion of treatment) were assessed during a five-month period on three predetermined, nonconsecutive days. The clinical indications for albumin were evaluated on the basis of Guidelines, a consensus document created by a multidisciplinary team for dissemination by the Governmental Health Authority to all hospitals within its purview. The data were abstracted from the patient case report forms by the pharmacist selected to compile the data in each of the participating hospitals.
  
  
  RESULTS
  A total of 242 forms reporting the use of 62,282 g of albumin were evaluated. The most frequent prescribing motives were nutritional intervention (23%), paracentesis in cirrhotic patients (19%), and radical surgery (11%). Only 59 prescriptions (24%), corresponding to 14,539 g of albumin (23%), were considered appropriate. The total cost of albumin therapy for the 242 cases was $183,796 (US$); $42,905 (23%) of this figure was the cost of appropriate use of albumin and $140,891 (77%) was the amount related to inappropriate use.
  
  
  CONCLUSIONS
  Evaluated against model guidelines, the use of most of the albumin, deemed clinically necessary by the prescribers, was considered unnecessary or inappropriate. Hence, institutions need to define and implement guidelines that focus on responsible use of such agents in an increasingly cost-conscious healthcare environment.
authors.affiliation: Pharmacy Department, Hospital Torrecárdenas, Almería, Spain. mtarinr@sefh.es
authors.forename: M J
authors.initials: MJ
authors.lastname: Tarín Remohí
authors.forename: A
authors.initials: A
authors.lastname: Sánchez Arcos
authors.forename: B
authors.initials: B
authors.lastname: Santos Ramos
authors.forename: J
authors.initials: J
authors.lastname: Bautista Paloma
authors.forename: M D
authors.initials: MD
authors.lastname: Guerrero Aznar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000418:Albumins / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D003625:Data Collection; D003627:Data Interpretation, Statistical; D011307:Drug Prescriptions; D004363:Drug Utilization; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D013030:Spain
chemical_list: D000418:Albumins