OBJECTIVES: To construct a budget impact model (BIM) to evaluate the economic impact of a combination of 5% albumin and crystalloids compared to crystalloids alone as fluid therapy administered to patients within one day of undergoing on-pump coronary artery bypass graft (CABG) and/or valve procedures. METHODS: Model parameters were obtained from clinical outcomes determined from a propensity-matched retrospective US electronic health record (EHR) database (Health Facts, Cerner) analysis performed to assess the differences in patient outcomes for those who received albumin and crystalloid solutions versus crystalloids alone for fluid therapy post cardiac surgery. The BIM was developed to evaluate the economic impact of increased usage of 5% albumin for volume therapy within one day of undergoing on-pump cardiac surgery. The model utilizes economic costs for treating complications obtained from published literature and reports as well as data from the EHR database analysis. The BIM covers a 2-year period and presents annual and cumulative costs from both a total hospital and total pharmacy perspective. RESULTS: A base case analysis for a hospital performing 100 cardiac surgeries per month results in a 2-yr cumulative savings of $1.32MM, assuming that 70% of patients require fluid resuscitation. The increased fluids cost associated with increased 5% albumin utilization is offset by reduced costs in hospital readmissions and treating fewer complications of pneumonia, acute kidney injury (AKIN stage III) and electrolyte abnormalities. In-hospital mortality was significantly lower in patients receiving 5% albumin (2.4% vs. 4.1% for crystalloids alone, p=0.02) which is reported strictly as a clinical outcome within the model. CONCLUSIONS: There are both clinical and economic advantages associated with increased utilization of 5% albumin for fluid therapy in patients following on-pump cardiac surgery. Hospital analysis of cardiac procedure outcomes and economics is particularly relevant given recent CMS value-based purchasing initiatives.