The Evaluation of Albumin Use in an Iranian University Hospital

Abstract

Background: Albumin is an expensive protein colloidal solution with various indications, especially in critically ill patients. The vast use of albumin in health care centers (particularly ICUs), the theoretical danger of contaminant transmission (as with any blood derivative), and the existence of more economical alternatives of equal efficacy evidence the importance of conducting a drug-utilization evaluation. The objective of this study was to assess the usage of albumin in patients at a hospital in Iran. Methods: Albumin administration was evaluated in 210 patients from different wards on randomly selected days during one year. Reasons for the prescription, the consumed dose, length of administration, and related laboratory tests were recorded. Results: Albumin was prescribed inappropriately in 76.2% and appropriately in 23.8% of inpatients. The most frequent inappropriate prescribing motives were hypoalbuminemia (35.6%), nutritional support (32.5%), and edema (24.4%), while the most appropriate prescriptions were edema (46%), nephrotic syndrome (18%), and plasmapheresis (16%). The total amount of albumin used for 210 patients was 68930 g, from which 51290 g costing $274607.1429 was administered for inappropriate indications. Conclusion: Despite the many valid guidelines defining the appropriate indications of albumin, this study demonstrated the extensive inappropriate use of this expensive preparation in one of the largest university-affiliated hospitals in northwestern Iran. It seems advisable to have the consumption of albumin continuously monitored.

Keywords: Albumin, Drug utilization Evaluation (DUE), Rational Therapy, Clinical Practice Guidelines