The COASST study: Cost-effectiveness of albumin in severe sepsis and septic shock

IntroductionThe cost-effectiveness of albumin-based fluid support in patients with severe sepsis is not known.MethodsWe compared standard medical practice and systematic albumin infusion. The study population consisted of patients with severe sepsis and/or septic shock admitted to one of the 35 intensive care units belonging to the Cub-Réa regional database between 1 January 1998 and 31 December 2002. Only stays longer than 24 hours and only patients with a minimum of circulatory, renal, or respiratory failure were considered. Cost estimates were based on French diagnosis-related groups and fixed daily prices. A 4.6% reduction in mortality was expected in the albumin arm, as observed in the Saline vs Albumin Fluid Evaluation (SAFE) Study. Life expectancy was estimated with the declining exponential approximation of life expectancy method, based on age, sex, Simplified Acute Physiology Score II, and McCabe score.ResultsThe number of lives saved among the 11 137 patients was 513. The average life expectancy of the 5156 patients who left the hospital alive was estimated to be 9.78 years. The costs per life saved and per year life saved were €6037 and €617, respectively. Sensitivity analyses confirmed the robustness of the results.ConclusionThe application of the SAFE Study results to CUB-Réa data shows that albumin infusion is cost-effective in severe sepsis.