The value of Cochrane reviews for informing health decisions on optimal use of albumin
Albumin is a plasma derivative widely used in routine clinical practice. However, its administration in some scenarios is not always justified by evidence of benefit in relevant clinical outcomes. This, together with the increasing consumption and the limited availability, makes it necessary to review its indications for use.
Objectives: To analyse the existence of evidence from systematic reviews on the efficacy and safety of albumin in different scenarios. To describe the value of Cochrane systematic reviews for decision-making in clinical practice and the impact on the efficient use of health resources.
Methods: A search for Cochrane systematic reviews was conducted in December 2019. This evidence was complemented by non-Cochrane reviews. The identified evidence was evaluated by a multidisciplinary committee, which established the criteria for the use of albumin in Navarre (Spain) based on these data. Subsequently, we assessed the impact of the measures adopted on albumin consumption and expending.
Results: We identified four Cochrane reviews [two in people with cirrhosis (Simonetti RG 2019, Best LM 2019), one for resuscitation in critically ill people (Lewis SR 2018), and one in nephrotic syndrome (Ho JJ 2019)] and seven non-Cochrane reviews. Thirty-six percent of evidence synthesis products used were Cochrane reviews. Supported by this evidence, measures for its appropriate use were adopted. In critically ill patients, albumin was restricted to shock, traumatic coagulopathy, surgery and burns refractory to crystalloids. In patients with cirrhosis, adequate indication was established after paracentesis >5 liters. In spontaneous bacterial peritonitis, it was restricted to high-risk patients. In hepatorenal syndrome, it should be used in combination with vasoconstrictors. In patients with cirrhosis with severe oedema, a maximum of 10 g/day was established. Albumin concentration in plasmapheresis was reduced from 5% to 4%. Routine use of albumin is not justified in other clinical conditions. Following the establishment of usage criteria, consumption decreased by 12.4% in 2020 and 19.4% in 2021 compared with 2019, with a savings of approximately €67,000.
Conclusions: Cochrane reviews facilitate decision-making in clinical practice, resulting in better utilisation of available resources.
Patient, public and/or healthcare consumer involvement: None.