Economic cost of long-term albumin treatment in cirrhotic patients with uncomplicated ascites based on the ANSWER trial: The Spanish healthcare system perspective

Background and aims Cirrhosis represents the end-stage of chronic liver diseases. The ANSWER trial showed that long-term albumin (LTA) administration along with the standard medical treatment (SMT) improves survival and reduces complications in patients with decompensated cirrhosis and uncomplicated ascites. The present analysis compared the potential annual cost of treatment with LTA + SMT, following the ANSWER regimen, with respect to SMT alone in patients with decompensated cirrhosis and uncomplicated ascites from the Spanish healthcare system perspective. Methods Cost of illness for patients with cirrhosis and uncomplicated ascites, treated with SMT alone or LTA + SMT (ANSWER regimen), was estimated. The annual incidence of complications and treatment frequency were collected based on the findings from the ANSWER trial. Unit costs were obtained from published data and transformed to 2019 Euros. The incremental cost was the difference in annual cost per patient between LTA + SMT and SMT alone treatment groups. A univariate sensitivity analysis was performed to ensure the robustness of the analysis. Results The annual cost per patient of treatment and management of complications was estimated at €26,161 for patients treated with LTA + SMT, compared to €27,536 for those treated with SMT alone, representing saving costs of €1,375 per patient and year. Conclusions By translating the ANSWER trial results to the Spanish clinical setting, LTA + SMT could reduce the healthcare cost associated with the management of cirrhotic patients with uncomplicated ascites due to the reduction of costly complications, which counterbalance the cost of LTA.