title: MELD score and albumin replacement are related to higher costs during management of patients with refractory ascites.
abstract: BACKGROUND
  Ascites is the most common complication of cirrhosis and indicates that the disease is at an advanced stage. In cirrhotic patients with refractory ascites, treatment is based on repeat paracentesis. The objective of this study is to evaluate the cost of paracentesis in cirrhotic patients and to determine the factors related to this cost.
  
  
  METHODS
  This prospective study included all patients with cirrhosis who underwent paracentesis between March 2012 and March 2013 at the Outpatient Service of the Liver Transplantation Unit, Clinical Hospital, University of São Paulo School of Medicine. Microcost analysis was performed with individual tabbed data regarding the consumption of albumin and containers for ascites. The remaining cost components were drugs, materials used during the procedure, and human resources. Statistical analysis was performed using SPSS version 20.
  
  
  RESULTS
  We conducted a total of 881 paracentesis procedures in a group of 155 patients that included 60.5% men and 39.5% women with a mean age of 57 years (range 20 to 80 years). Patients underwent an average of 5.3 paracentesis procedures per year (range 1 to 32). The total cost of all procedures was $193,126.60 and the most costly component was albumin ($87,162.10). The average cost per procedure was $219.50. The most frequent liver disease diagnoses were hepatitis C (24%) and alcoholic cirrhosis (24%). The majority of patients were on the liver transplant list (54.2%). Factors associated with higher costs in the period were a Model for End-Stage Liver Disease score higher than 24 (P = .001) and patients on the transplant waiting list (P = .042).
  
  
  CONCLUSIONS
  Paracentesis in cirrhotic patients is a high-cost procedure in health care. The main factors related to cost are the volume of fluid drained due to the need for albumin replacement and the severity of liver disease that is related to the frequency of paracentesis.
authors.affiliation: Digestive Transplant Unit, Gastroenterology Department, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: V
authors.initials: V
authors.lastname: Borges de Santana
authors.affiliation: Digestive Transplant Unit, Gastroenterology Department, University of São Paulo School of Medicine, São Paulo, Brazil. Electronic address: luciana.haddad@hc.fm.usp.br.
authors.forename: L
authors.initials: L
authors.lastname: Bertocco de Paiva Haddad
authors.affiliation: University of São Paulo Nursery School, São Paulo, Brazil.
authors.forename: T
authors.initials: T
authors.lastname: Morgado Conte
authors.affiliation: Digestive Transplant Unit, Gastroenterology Department, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: A
authors.initials: A
authors.lastname: Cortez Rizzon
authors.affiliation: Digestive Transplant Unit, Gastroenterology Department, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: V
authors.initials: V
authors.lastname: Miranda Barbosa
authors.affiliation: University of Michigan Medical School, Ann Arbor, Michigan, USA.
authors.forename: W
authors.initials: W
authors.lastname: Shield
authors.affiliation: Digestive Transplant Unit, Gastroenterology Department, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: W
authors.initials: W
authors.lastname: Andraus
authors.affiliation: Digestive Transplant Unit, Gastroenterology Department, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: L
authors.initials: L
authors.lastname: Augusto Carneiro D'Albuquerque
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000418:Albumins / Q000191:economics / Q000627:therapeutic use*; D001201:Ascites / Q000191:economics / Q000209:etiology / Q000628:therapy*; D001938:Brazil; D003131:Combined Modality Therapy; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000191:economics; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000191:economics*; D019152:Paracentesis / Q000191:economics*; D011446:Prospective Studies; D012720:Severity of Illness Index
chemical_list: D000418:Albumins