OBJECTIVES: SBP is a common, life-threatening complication of cirrhosis that imposes a substantial and growing healthcare cost burden. Treatment guidelines from the American Association for the Study of Liver Diseases recommend albumin administration in conjunction with antibiotics for SBP management due to albumin’s demonstrated clinical efficacy and safety. We examined the relationship between albumin infusion timing and total hospitalization cost among cirrhotic inpatients who developed SBP during hospitalization.

METHODS: Using ICD-10 and billing codes, we performed a cross-sectional study using inpatient data from the Premier Healthcare Database corresponding to adult cirrhotic patients who developed SBP and received antibiotics, between Jan-2016 and Jun-2019. The ‘early albumin’ group included patients who received albumin within 1 day of hospitalization, whereas the ‘non-early’ group received albumin after day 1 of hospitalization or not at all. Propensity score matching (PSM) (1:1) was used to balance both cohorts by sociodemographic characteristics, baseline Elixhauser Comorbidity Index, and presence of hepatorenal syndrome, end-stage renal disease, and ascites. Generalized linear models were employed to determine the association between albumin infusion timing and total hospitalization cost, controlling for common comorbidities (e.g., gastrointestinal bleeding). Total hospitalization cost consisted of fixed costs plus variable costs (volume-linked expenses such as supplies and patient care).

RESULTS: PSM yielded a total of 10,326 patients, of whom 8,482 survived to discharge. A risk-adjusted cost ratio (CR) model showed that, compared to the non-early group, early albumin was associated with an 11% total cost reduction among all patients (CR: 0.89, 95% CI: 0.86-0.91, p<0.001) and among survivors (CR: 0.89, 95% CI: 0.87-0.92, p<0.001).

CONCLUSIONS: Early albumin infusion was associated with a significant reduction in total hospitalization cost regardless of survivorship. These findings suggest that albumin as an adjuvant to antibiotics may alleviate the growing cost burden of SBP as a complication of cirrhosis.