Choice of Fluids in Severe Septic Patients - A Cost-effectiveness Analysis Informed by Recent Clinical Trials
Albert Farrugia, Megha Bansal, Sonia Balboni, Mary Clare Kimber, Gregory S. Martin and Josephine Cassar
Affiliation: 147 Old Solomons Island Road, Suite#100, Annapolis, MD 21401, Australia.
Fluid resuscitation with colloids is an established second line therapy for septic patients. Evidence of relative
efficacy outcomes is tempered by considerations of the relative costs of the individual fluids. An assessment of recent
large clinical trials was performed, resulting in a ranking in the efficacy of these therapies. Probabilities for mortality and
the need for renal replacement therapy (RRT) were derived and used to inform a decision analysis model comparing the
effect of crystalloid, albumin and hydroxyethyl starch solutions in severe septic patients followed from hospital admission
to 90 days in intensive care. The US payer perspective was used. Model inputs for costs and efficacy were derived from
the peer-reviewed literature, assuming that that all fluid preparations are bio-equivalent within each class of these therapies.
Probabilities for mortality and the need for renal replacement therapy (RRT) data were synthesized using a Bayesian
meta-analysis. Relative to crystalloid therapy, 0.21 life years were gained with albumin and 0.85 life years were lost with
hydroxyethyl starch. One-way sensitivity analysis showed that the model’s outcomes were sensitive to the cost of RRT
but not to the costs of the actual fluids or any other costs. We conclude that albumin may be the most cost-effective treatment
in these patients when the total medical costs and iatrogenic morbidities involved in treating sepsis with fluids are
considered. These results should assist and inform decision making in the choice of these drugs.
Keywords: Clinical trials, colloids, costs, decision analysis, fluid therapies, sepsis.
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