CLINICAL TRIALS E. Vargas á V. de Miguel á A. PortoleÂs C. AvendanÄo á M. I. Ambit á A. Torralba á A. Moreno Use of albumin in two Spanish university hospitals Received: 31 July 1996 / Accepted in revised form: 20 January 1997 Abstract Objectives: The aim of this study was to characterize the use of seralbumin, evaluating how ap- propriate its prescription is and what possible economic repercussions may result from inappropriate use. Methods: We performed a prospective study that in- cluded all patients receiving albumin in two University Hospitals from October 1995 to March 1996. The rea- sons for albumin use were considered appropriate if they coincided with the recommendations of a panel of ex- perts. Results: During the study period, 197 patients received albumin and a total of 3208 50-ml vials (20%) were used. The internal medicine and gastroenterology ser- vices prescribed this drug the most often. The most frequent prescription motives were paracentesis in cir- rhotic patients (25.9%), hypoalbuminemia (24.9%) and chronic handling of cirrhotic patients (18.6%). Only 16 prescriptions (8.1%) (corresponding to 315 vials, 9.8%) were considered appropriate. One cause of inappropri- ate prescribing was that colloid solutions had not pre- viously been used in 56 (30.9%) of the 186 inappropriate prescriptions. During the study period, 74 306 ECUs were spent on inappropriate indications. Conclusions: The use of albumin in our centers is in- correct and has important economic repercussions. Some educational and informative measures must be established to change this situation. Key words Albumin, Drug Usage Evaluation; Cost, Drug Utilization Introduction Obtaining and purifying human seralbumin is a dicult process that leads to high costs and some supply limita- tions. Since it was marketed in the 1940s, the growing use of albumin in clinical practice has provoked controversy because its use was largely based on pathophysiological reasons and not on correctly designed clinical trials. Thus, the ecacy was not evaluated adequately and the role of albumin, compared with other less expensive therapeutic alternatives, such as other colloids (COL) or crystalloid solutions (CS), was not clearly de®ned. This lack of clinical evidence of ecacy in absolute and/or compara- tive terms might have given rise to some confusion and great variability regarding what should be considered as appropriate indications. Thus, in the 1970s, the National Institutes of Health of the United States (N.I.H.) decided to promote the development and publication of guide- lines for use, based on the opinion of expert groups [1, 2]. Diusion of these guidelines, through an educational program in some health-care centers, improved the rate of product prescription [3]. However, its overall impact was apparently not very high since several reports [4±7], which have indicated a high percentage of incorrect use, have appeared since its publication. Human seralbumin has been of concern to the Pharmacy and Therapeutics Commission in our hospi- tals because a signi®cant level of inappropriate use, due to its high consumption is perceived. Other pharmacy commissions in our country have also shown interest in this drug [8±10], since the cost of albumin in some cen- ters represents up to 10% of the drug-expense section [8]. Some centers have even published their own criteria for use [11]. In 1995, new guidelines were published by Vermeulen et al. [12]. Because their studies were performed sys- tematically, after evaluation of a large volume of medical Eur J Clin Pharmacol (1997) 52: 465±470 Ó Springer-Verlag 1997 E. Vargas (&) á V. de Miguel á A. PortoleÂs á A. Moreno Clinical Pharmacology Service, Hospital Universitario San Carlos, c/Martin Lagos s/n, Madrid E-28040, Spain Tel: +91 330 3413; Fax: +91 330 3299 C. AvendanÄo Clinical Pharmacology Service, ClõÂnica Puerta de Hierro, Madrid, Spain M.I. Ambit Pharmacy Service, Hospital Universitario San Carlos, Madrid, Spain A. Torralba Pharmacy Service, ClõÂnica Puerta de Hierro, Madrid, Spain