Financial impact of intravenous iron treatments on the management of anaemia inpatients: a 1 year observational study
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Background Intravenous (IV) iron preparations bypass the difficulties (malabsorption and side effects) associated with oral iron for the treatment of iron deficiency anaemia (IDA). Ferric carboxymaltose (FCM) can be administered as a single infusion over short periods of time but is more expensive than iron sucrose (IS) when the patients are hospitalized. Objectives To evaluate the appropriateness of FCM prescriptions and to establish the economic impact of this management (including disease coding) compared to the use of IV IS. Setting This study was conducted for inpatients in all departments (orthopaedic department, gastroenterology department and two units of the internal medicine department) where FCM was widely prescribed. Method We retrospectively identified 224 patients, diagnosed with IDA using laboratory parameters and/or disease coding, who received FCM between January and December 2014. Main outcome measure The primary outcome was the rate of appropriateness of FCM prescriptions and the financial impact compared to IV IS. Results 89 Patients were included. The total additional cost for an inappropriate prescription of IV FCM (68% of cases) was of 6053 €. The total incremental cost of unsuitable disease coding was estimated at 31,688 €. Indications for IV FCM were categorized: intestinal bleeding (31%), malabsorption (17%), intolerance (9%) and refractory to oral iron (7%). The majority of patients (62%) received 1000 mg of FCM per week. The average length of hospital stay was of 10 days. Conclusion The prescription of IV iron was appropriate in most cases but did not necessarily require FCM. The use of IV IS, in many cases, could present a cost-saving option for inpatients with IDA. The lack of an IDA coding generated incremental costs.
KeywordsAnaemia Cost Efficiency Ferric carboxymaltose France Iron deficiency Iron sucrose
No specific funding for this work to declare
Conflicts of interest
All the authors declare that they have no conflicts of interest.
- 1.Rognoni C, Venturini S, Meregaglia M, Marmifero M, Tarricone R. Efficacy and safety of ferric carboxymaltose and other formulations in iron-deficient patients: a systematic review and network meta-analysis of randomised controlled trials. Clin Drug Investig. 2016;36(3):177–94.CrossRefPubMedGoogle Scholar
- 5.Vifor France SA. Ferinject summary of product characteristics. 2009; http://www.medicines.org.uk/EMC/medicine/24167/SPC/Ferinject+(ferric+carboxymaltose). Accessed 23 May 2017.
- 6.Vifor (International) Inc. Venofer (iron sucrose injection USP). http://www.medicines.org.uk/EMC/medicine/24168/SPC/Venofer+(iron+sucrose)/. Accessed 23 May 2017.
- 8.Fragoulakis V, Kourlaba G, Goumenos D, Konstantoulakis M, Maniadakis N. Economic evaluation of intravenous iron treatments in the management of anemia patients in Greece. Clin Outcomes Res CEOR. 2012;4:127–34.Google Scholar
- 11.Locatelli F, Bárány P, Covic A, De Francisco A, Del Vecchio L, Goldsmith D, et al. Kidney disease: improving global outcomes guidelines on anaemia management in chronic kidney disease: a European Renal Best Practice position statement. Nephrol Dial Transpl Off Publ Eur Dial Transpl Assoc Eur Ren Assoc. 2013;28(6):1346–59.Google Scholar
- 15.Calvet X, Gené E, ÀngelRuíz M, Figuerola A, Villoria A, Cucala M, et al. Cost-minimization analysis favours intravenous ferric carboxymaltose over ferric sucrose or oral iron as preoperative treatment in patients with colon cancer and iron deficiency anaemia. Technol Health Care Off J Eur Soc Eng Med. 2016;24(1):111–20.Google Scholar
- 16.Muñoz M, Gómez-Ramírez S, Martín-Montañez E, Naveira E, Seara J, Pavía J. Cost of post-operative intravenous iron therapy in total lower limb arthroplasty: a retrospective, matched cohort study. Blood Transfus Trasfus Sangue. 2014;12(1):40–9.Google Scholar