Skip to main content
Top

Open Access 19-03-2024 | Iron Deficiency Anemia | Original Research Article

Effect of Ferric Carboxymaltose Versus Low-Dose Intravenous Iron Therapy and Iron Sucrose on the Total Cost of Care in Patients with Iron Deficiency Anemia: A US Claims Database Analysis

Authors: Winghan Jacqueline Kwong, Kevin Wang, Peng Wang, Ralph Boccia

Published in: Drugs - Real World Outcomes

Login to get access

Abstract

Background and Objective

Iron deficiency is the most common cause of anemia. We compared the effect of ferric carboxymaltose (FCM), low-dose intravenous (IV) iron (LDI), and iron sucrose on total cost of care in patients with iron-deficiency anemia (IDA) from a US health plan perspective.

Methods

We conducted a retrospective claims analysis using the IQVIA PharMetrics Plus database. Patients with index (first) claims of FCM and LDI and a medical claim associated with IDA between 1 January 2017 and 31 December 2019 were included. Monthly total healthcare and inpatient and outpatient costs after receiving index IV iron for patients in the treatment cohorts were compared using a generalized linear model with gamma distribution and log-link.

Results

The overall study cohort included 37,655 FCM, 44,237 LDI, and 27,461 iron sucrose patients. Mean per-patient-per-month numbers of IV iron infusions for FCM, LDI, and iron sucrose were 0.20, 0.34, and 0.37, respectively. Compared with baseline, the FCM group had greater reductions in the number of hospital admissions and smaller increases in the number of outpatient visits in the 12 months post-IV iron therapy than LDI and iron sucrose, translating to significantly lower total healthcare cost (post-index adjusted cost ratio for total cost: 0.96 and 0.92, respectively; both P < 0.0001).

Conclusions

Higher drug acquisition cost of FCM relative to LDI and iron sucrose was offset by significantly lower inpatient and outpatient costs in the 12 months post-IV iron therapy. These results support the economic value of FCM for patients with IDA receiving IV iron therapy.
Appendix
Available only for authorised users
Literature
1.
go back to reference LaVallee C, Cronin P, Bansal I, Kwong WJ, Boccia R. Importance of initial complete parenteral iron repletion on hemoglobin level normalization and health care resource utilization: a retrospective analysis. Pharmacotherapy. 2019;39:983–93.CrossRefPubMed LaVallee C, Cronin P, Bansal I, Kwong WJ, Boccia R. Importance of initial complete parenteral iron repletion on hemoglobin level normalization and health care resource utilization: a retrospective analysis. Pharmacotherapy. 2019;39:983–93.CrossRefPubMed
3.
go back to reference Mikhail A, Brown C, Williams JA, Mathrani V, Shrivastava R, Evans J, et al. Renal association clinical practice guideline on anaemia of chronic kidney disease. BMC Nephrol. 2017;18:345.CrossRefPubMedPubMedCentral Mikhail A, Brown C, Williams JA, Mathrani V, Shrivastava R, Evans J, et al. Renal association clinical practice guideline on anaemia of chronic kidney disease. BMC Nephrol. 2017;18:345.CrossRefPubMedPubMedCentral
4.
go back to reference Lopez A, Cacoub P, Macdougall IC, Peyrin-Biroulet L. Iron deficiency anaemia. Lancet. 2016;387:907–16.CrossRefPubMed Lopez A, Cacoub P, Macdougall IC, Peyrin-Biroulet L. Iron deficiency anaemia. Lancet. 2016;387:907–16.CrossRefPubMed
5.
go back to reference Ludwig H, Muldur E, Endler G, Hubl W. Prevalence of iron deficiency across different tumors and its association with poor performance status, disease status and anemia. Ann Oncol. 2013;24:1886–92.CrossRefPubMedPubMedCentral Ludwig H, Muldur E, Endler G, Hubl W. Prevalence of iron deficiency across different tumors and its association with poor performance status, disease status and anemia. Ann Oncol. 2013;24:1886–92.CrossRefPubMedPubMedCentral
6.
go back to reference McEwan P, Ponikowski P, Davis JA, Rosano G, Coats AJS, Dorigotti F, et al. Ferric carboxymaltose for the treatment of iron deficiency in heart failure: a multinational cost-effectiveness analysis utilising AFFIRM-AHF. Eur J Heart Fail. 2021;23:1687–97.CrossRefPubMed McEwan P, Ponikowski P, Davis JA, Rosano G, Coats AJS, Dorigotti F, et al. Ferric carboxymaltose for the treatment of iron deficiency in heart failure: a multinational cost-effectiveness analysis utilising AFFIRM-AHF. Eur J Heart Fail. 2021;23:1687–97.CrossRefPubMed
7.
go back to reference Maeder MT, Khammy O, dos Remedios C, Kaye DM. Myocardial and systemic iron depletion in heart failure implications for anemia accompanying heart failure. J Am Coll Cardiol. 2011;58:474–80.CrossRefPubMed Maeder MT, Khammy O, dos Remedios C, Kaye DM. Myocardial and systemic iron depletion in heart failure implications for anemia accompanying heart failure. J Am Coll Cardiol. 2011;58:474–80.CrossRefPubMed
8.
go back to reference Haddad S, Wang Y, Galy B, Korf-Klingebiel M, Hirsch V, Baru AM, et al. Iron-regulatory proteins secure iron availability in cardiomyocytes to prevent heart failure. Eur Heart J. 2017;38:362–72.PubMed Haddad S, Wang Y, Galy B, Korf-Klingebiel M, Hirsch V, Baru AM, et al. Iron-regulatory proteins secure iron availability in cardiomyocytes to prevent heart failure. Eur Heart J. 2017;38:362–72.PubMed
9.
go back to reference Jankowska EA, von Haehling S, Anker SD, Macdougall IC, Ponikowski P. Iron deficiency and heart failure: diagnostic dilemmas and therapeutic perspectives. Eur Heart J. 2013;34:816–29.CrossRefPubMed Jankowska EA, von Haehling S, Anker SD, Macdougall IC, Ponikowski P. Iron deficiency and heart failure: diagnostic dilemmas and therapeutic perspectives. Eur Heart J. 2013;34:816–29.CrossRefPubMed
10.
go back to reference Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. J Am Coll Cardiol. 2022;79:1757–80.CrossRefPubMed Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. J Am Coll Cardiol. 2022;79:1757–80.CrossRefPubMed
11.
go back to reference Pergola PE, Fishbane S, Ganz T. Novel oral iron therapies for iron deficiency anemia in chronic kidney disease. Adv Chronic Kidney Dis. 2019;26:272–91.CrossRefPubMed Pergola PE, Fishbane S, Ganz T. Novel oral iron therapies for iron deficiency anemia in chronic kidney disease. Adv Chronic Kidney Dis. 2019;26:272–91.CrossRefPubMed
12.
go back to reference Park YJ, Lim HS, Kim TH. Annual prevalence, health expenditures, and co-morbidities trend of iron deficiency anemia in Korea: National Health Insurance Service Data from 2002 to 2013. Int J Environ Res Public Health. 2020;17:4433. Park YJ, Lim HS, Kim TH. Annual prevalence, health expenditures, and co-morbidities trend of iron deficiency anemia in Korea: National Health Insurance Service Data from 2002 to 2013. Int J Environ Res Public Health. 2020;17:4433.
13.
go back to reference LaVallee C, Bansal I, Kamdar S, Kwong WJ, Boccia RV. Relationship between initial parenteral iron therapy dosing and treatment effectiveness: a real-world retrospective analysis. J Blood Med. 2022;13:133–42.CrossRefPubMedPubMedCentral LaVallee C, Bansal I, Kamdar S, Kwong WJ, Boccia RV. Relationship between initial parenteral iron therapy dosing and treatment effectiveness: a real-world retrospective analysis. J Blood Med. 2022;13:133–42.CrossRefPubMedPubMedCentral
15.
go back to reference Diehr P, Yanez D, Ash A, Hornbrook M, Lin DY. Methods for analyzing health care utilization and costs. Annu Rev Public Health. 1999;20:125–44.CrossRefPubMed Diehr P, Yanez D, Ash A, Hornbrook M, Lin DY. Methods for analyzing health care utilization and costs. Annu Rev Public Health. 1999;20:125–44.CrossRefPubMed
16.
go back to reference Olmos A, Govindasamy P. A practical guide for using propensity score weighting in R. Pract Assess Res Eval. 2019;20:13. Olmos A, Govindasamy P. A practical guide for using propensity score weighting in R. Pract Assess Res Eval. 2019;20:13.
17.
go back to reference Rakanita Y, Syamsunarno M, Sinuraya RK, Suradji EW, Abdulah R, Suwantika AA. Cost-effectiveness of ferrous fumarate-folic acid and ferrous gluconate-multivitamins in a high prevalence area of iron deficiency anemia in Indonesia. Ther Clin Risk Manag. 2021;17:1075–81.CrossRefPubMedPubMedCentral Rakanita Y, Syamsunarno M, Sinuraya RK, Suradji EW, Abdulah R, Suwantika AA. Cost-effectiveness of ferrous fumarate-folic acid and ferrous gluconate-multivitamins in a high prevalence area of iron deficiency anemia in Indonesia. Ther Clin Risk Manag. 2021;17:1075–81.CrossRefPubMedPubMedCentral
18.
go back to reference Wong G, Howard K, Hodson E, Irving M, Craig JC. An economic evaluation of intravenous versus oral iron supplementation in people on haemodialysis. Nephrol Dial Transplant. 2013;28:413–20.CrossRefPubMed Wong G, Howard K, Hodson E, Irving M, Craig JC. An economic evaluation of intravenous versus oral iron supplementation in people on haemodialysis. Nephrol Dial Transplant. 2013;28:413–20.CrossRefPubMed
19.
go back to reference Ray S, Neogi SB, Singh R, Devasenapathy N, Zodpey S. Is IV iron sucrose a cost-effective option for treatment of severe anaemia in pregnancy as compared with oral iron? Health Policy Plan. 2021;35:1339–46.CrossRefPubMed Ray S, Neogi SB, Singh R, Devasenapathy N, Zodpey S. Is IV iron sucrose a cost-effective option for treatment of severe anaemia in pregnancy as compared with oral iron? Health Policy Plan. 2021;35:1339–46.CrossRefPubMed
20.
go back to reference LaVallee C, Cronin P, Bansal I, Kwong WJ, Boccia RV. Effectiveness of parenteral iron therapy in the real-world setting: a retrospective analysis. J Clin Haematol. 2020;1:16–25. LaVallee C, Cronin P, Bansal I, Kwong WJ, Boccia RV. Effectiveness of parenteral iron therapy in the real-world setting: a retrospective analysis. J Clin Haematol. 2020;1:16–25.
21.
go back to reference Gafter-Gvili A, Rozen-Zvi B, Vidal L, Leibovici L, Vansteenkiste J, Gafter U, et al. Intravenous iron supplementation for the treatment of chemotherapy-induced anaemia—systematic review and meta-analysis of randomised controlled trials. Acta Oncol. 2013;52:18–29.CrossRefPubMed Gafter-Gvili A, Rozen-Zvi B, Vidal L, Leibovici L, Vansteenkiste J, Gafter U, et al. Intravenous iron supplementation for the treatment of chemotherapy-induced anaemia—systematic review and meta-analysis of randomised controlled trials. Acta Oncol. 2013;52:18–29.CrossRefPubMed
22.
go back to reference Dangsuwan P, Manchana T. Blood transfusion reduction with intravenous iron in gynecologic cancer patients receiving chemotherapy. Gynecol Oncol. 2010;116:522–5.CrossRefPubMed Dangsuwan P, Manchana T. Blood transfusion reduction with intravenous iron in gynecologic cancer patients receiving chemotherapy. Gynecol Oncol. 2010;116:522–5.CrossRefPubMed
23.
go back to reference Anker SD, Kirwan BA, van Veldhuisen DJ, Filippatos G, Comin-Colet J, Ruschitzka F, et al. Effects of ferric carboxymaltose on hospitalisations and mortality rates in iron-deficient heart failure patients: an individual patient data meta-analysis. Eur J Heart Fail. 2018;20:125–33.CrossRefPubMed Anker SD, Kirwan BA, van Veldhuisen DJ, Filippatos G, Comin-Colet J, Ruschitzka F, et al. Effects of ferric carboxymaltose on hospitalisations and mortality rates in iron-deficient heart failure patients: an individual patient data meta-analysis. Eur J Heart Fail. 2018;20:125–33.CrossRefPubMed
24.
go back to reference Macdougall IC, White C, Anker SD, Bhandari S, Farrington K, Kalra PA, et al. Intravenous iron in patients undergoing maintenance hemodialysis. N Engl J Med. 2019;380:447–58.CrossRefPubMed Macdougall IC, White C, Anker SD, Bhandari S, Farrington K, Kalra PA, et al. Intravenous iron in patients undergoing maintenance hemodialysis. N Engl J Med. 2019;380:447–58.CrossRefPubMed
25.
go back to reference Macdougall IC. Intravenous iron therapy in patients with chronic kidney disease: recent evidence and future directions. Clin Kidney J. 2017;10:i16–24.CrossRefPubMedPubMedCentral Macdougall IC. Intravenous iron therapy in patients with chronic kidney disease: recent evidence and future directions. Clin Kidney J. 2017;10:i16–24.CrossRefPubMedPubMedCentral
26.
go back to reference Rognoni C, Ortalda V, Biasi C, Gambaro G. Economic evaluation of ferric carboxymaltose for the management of hemodialysis patients with iron deficiency anemia in Italy. Adv Ther. 2019;36:3253–64.CrossRefPubMedPubMedCentral Rognoni C, Ortalda V, Biasi C, Gambaro G. Economic evaluation of ferric carboxymaltose for the management of hemodialysis patients with iron deficiency anemia in Italy. Adv Ther. 2019;36:3253–64.CrossRefPubMedPubMedCentral
27.
go back to reference Aiello A, Berto P, Conti P, Panichi V, Rosati A. Economic impact of ferric carboxymaltose in haemodialysis patients. Gior Ital Nefrol. 2020;37(Suppl 75):2020-S75. Aiello A, Berto P, Conti P, Panichi V, Rosati A. Economic impact of ferric carboxymaltose in haemodialysis patients. Gior Ital Nefrol. 2020;37(Suppl 75):2020-S75.
28.
go back to reference 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. 2016;24:111–20.CrossRefPubMed 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. 2016;24:111–20.CrossRefPubMed
29.
go back to reference Cirillo L, Somma C, Allinovi M, Bagalà A, Ferro G, Di Marcantonio E, et al. Ferric carboxymaltose vs. ferrous sulfate for the treatment of anemia in advanced chronic kidney disease: an observational retrospective study and cost analysis. Sci Rep. 2021;11:7463.CrossRefPubMedPubMedCentral Cirillo L, Somma C, Allinovi M, Bagalà A, Ferro G, Di Marcantonio E, et al. Ferric carboxymaltose vs. ferrous sulfate for the treatment of anemia in advanced chronic kidney disease: an observational retrospective study and cost analysis. Sci Rep. 2021;11:7463.CrossRefPubMedPubMedCentral
30.
go back to reference Joosten E, Lioen P. Iron deficiency anemia and anemia of chronic disease in geriatric hospitalized patients: how frequent are comorbidities as an additional explanation for the anemia? Geriatr Gerontol Int. 2015;15:931–5.CrossRefPubMed Joosten E, Lioen P. Iron deficiency anemia and anemia of chronic disease in geriatric hospitalized patients: how frequent are comorbidities as an additional explanation for the anemia? Geriatr Gerontol Int. 2015;15:931–5.CrossRefPubMed
32.
go back to reference Zaninetti C, Klersy C, Scavariello C, Bastia R, Balduini CL, Invernizzi R. Prevalence of anemia in hospitalized internal medicine patients: Correlations with comorbidities and length of hospital stay. Eur J Intern Med. 2018;51:11–7.CrossRefPubMed Zaninetti C, Klersy C, Scavariello C, Bastia R, Balduini CL, Invernizzi R. Prevalence of anemia in hospitalized internal medicine patients: Correlations with comorbidities and length of hospital stay. Eur J Intern Med. 2018;51:11–7.CrossRefPubMed
33.
go back to reference Institute of Medicine. America’s uninsured crisis: consequences for health and health care. Washington, DC: The National Academies Press; 2009. Institute of Medicine. America’s uninsured crisis: consequences for health and health care. Washington, DC: The National Academies Press; 2009.
Metadata
Title
Effect of Ferric Carboxymaltose Versus Low-Dose Intravenous Iron Therapy and Iron Sucrose on the Total Cost of Care in Patients with Iron Deficiency Anemia: A US Claims Database Analysis
Authors
Winghan Jacqueline Kwong
Kevin Wang
Peng Wang
Ralph Boccia
Publication date
19-03-2024
Publisher
Springer International Publishing
Published in
Drugs - Real World Outcomes
Print ISSN: 2199-1154
Electronic ISSN: 2198-9788
DOI
https://doi.org/10.1007/s40801-024-00418-1