ALBUMIN AND NONPROTEIN COLLOID SOLUTION USE IN US ACADEMIC HEALTH CENTERS

Background: Crystalloids, nonprotein colloids (NPCs), and albumin are used for many indications. The use of the least costly agent in situat ions where these products are clinically interchangeable can reduce he alth care costs. Objectives: To characterize the prescribing of albumi n and NPC. To evaluate the appropriateness and cost implications of th eir use. Methods: An observational study conducted in 15 academic heal th centers from April 11 through May 6, 1994, to assess the appropriat eness of albumin and NPC use, based on ''model'' consensus-derived ind ication guidelines. Results: A total of 969 case report forms were eva luated. Albumin and NPCs were administered in 83% and 17% of the cases , respectively. Albumin and NPCs were administered mostly in the inten sive care (50%) or operating room (31%) settings. The most common pres cribers of these products were surgeons (45%) and anesthesiologists (2 0%). In 87% of cases, albumin or NPC was administered to reach a defin ed end point (eg, to achieve a target physiological state or to resolv e a pathophysiological condition). Only one albumin recipient experien ced an adverse event; no adverse events were noted with NPC administra tion. Approximately $203 000 was spent on albumin and NPC therapy for the 969 cases; $49 702 (24%) was spent on appropriate administrations, $124 939 (62%) on inappropriate administrations, and $28 014 (14%) on unevaluated indications. Conclusions: Evaluated against model guideli nes, most of the albumin and NPC use in the study was found to be inap propriate. The need for institutions to define and implement guideline s that focus on the cost-efficient use of these agents is recommended in an increasingly cost-conscious health care environment.