(P-329) Evaluation of Albumin Utilization in a Major Teaching Hospital in Iran Before and After Guideline Implementation

Background: Lately, the increased drug costs due to inappropriate use of medications have become a major issue in the health care system management. Drug Utilization Evaluation (DUE) is of great importance for expensive and great volume drugs a due to their clinical and economic impact.

Objectives: We aimed to evaluate albumin usage's appropriateness and optimize its use in Razi Research and Remedial Center of Rasht, Iran.

Methods: This study was a prospective cross-sectional pre-post interventional study, which was conducted in 2‑months phases at Razi Educational Remedial & Research Center, a referral teaching hospital affiliated to Guilan university of medical sciences, Rasht, Iran, and all patients with albumin prescriptions in each phase were recruited into the study. The first phase was done in November and December of 2017, during which a guideline was designed, and based on physicians' comments, it was finalized and then implemented. We performed phase two in May and June 2018. We evaluated and compared the appropriateness of albumin usage before and after guideline implementation. Data analysis was done using SPSS software (version 25.0; SPSS Inc., Chicago, Illinois, USA). The Chi-square test was used for nominal variables. The independent t-test was also used to compare the differences before and after implementing the protocol (first and second phases) for quantitative variables.

Results: Total number of 60 and 61 forms were collected during phase one and phase two, respectively. Albumin was prescribed appropriately in thirty-three patients (55%) in phase one and forty-three (70%) patients in phase two. A total number of 299 vials in phase one and 456 vials in phase two were prescribed which 198 vials (66%) and 394 (86%) vials were used for appropriate indications, respectivelythe number of vials consumed with inappropriate indication decreased significantly from 101 vials (34%) in the first phase to 62 vials (14%) in the second phase (P value = 0.01). In the first phase, the total cost of consuming albumin was $10,512, and in the second phase was $16,032. The average cost of the inappropriate indication per patient decreased from $197.3 ± 131.6 in the first phase to $183.5 ± 126.8 in the second phase (P value = 0.52).

Conclusions: This study showed that albumin use was inappropriate in some cases in this hospital. This study showed that implementing a DUE program and designing a guideline for rational prescribing of albumin and intervention methods such as continuing education and feedback for albumin prescribing can optimize treatment duration and significantly decrease inappropriate vials' usage, avoiding unnecessary hospital costs.