Top

Cost Effectiveness and Resource Allocation

Published in:

Open Access 01-12-2014 | Research

Cost-utility of ferric carboxymaltose (Ferinject®) for iron-deficiency anemia patients with chronic heart failure in South Korea

Authors: Eun-A Lim, Hyun-Soon Sohn, Haeyoung Lee, Sang-Eun Choi

Published in: Cost Effectiveness and Resource Allocation | Issue 1/2014

Abstract

Background

Iron-deficiency anemia (IDA) is prevalent in patients with advanced chronic heart failure (CHF). It affects the patients’ overall physical condition and is suggested as a strong outcome predictor in CHF. Recent clinical trials suggested that intravenous iron supplementation improves CHF functional status and quality of life. The aim of this study was to assess the cost-effectiveness of ferric carboxymaltose(FCM) in CHF patients with IDA.

Methods

Ferric carboxymaltose, an intravenous iron preparation, was compared with placebo. The target population comprised CHF patients with IDA in hospital and outpatient care settings. We conducted this study from the Korean healthcare payers’ perspective with a time horizon of 24 weeks. One clinical trial provided the clinical outcomes of ferric carboxymaltose therapy. The improvement rates of the New York Heart Association (NYHA) functional class in the placebo and ferric carboxymaltose groups were used to estimate effectiveness in the base-case model. We also conducted a scenario 2 analysis using quality of life investigated in the clinical trial. A panel survey was conducted to obtain the ratio of healthcare resource use based on NYHA class in Korea. Cost-effectiveness was expressed as incremental cost (US dollars) per quality-adjusted life-year (QALY) gained.

Results

In the base-case analysis, the incremental cost-effectiveness ratio (ICER) of ferric carboxymaltose compared with placebo was $22,192 (₩25,010,451) per QALY gained. The sensitivity analysis showed robust results, with the ICERs of ferric carboxymaltose ranging from $5,156 to $29,796 per QALY gained. In the scenario 2 analysis, ICER decreased to $12,598 (₩14,198,501) per QALY gained.

Conclusions

Iron repletion with ferric carboxymaltose for IDA in CHF patients was cost-effective compared with placebo.

Available only for authorised users

Ngo K, Kotecha D, Walters JA, Manzano L, Palazzuoli A, van Veldhuisen DJ, Flather M: Erythropoiesis-stimulating agents for anaemia in chronic heart failure patients. Cochrane Database Syst Rev 2010.,20(1): CD007613

Heo JH, Kim HS, Jang BJ, Shin JG, Yang DH, Park HS, Jo YK, Chae SC, Jun JE, Park WH: Anemia is associated with higher mortality in severe heart failure. Korean Circ J 2005,35(10):773–778. Korean 10.4070/kcj.2005.35.10.773CrossRef

Silverberg DS, Wexler D, Blum M, Keren G, Sheps D, Leibovitch E, Brosh D, Laniado S, Schwartz D, Yachnin T, Shapira I, Gavish D, Baruch R, Koifman B, Kaplan C, Steinbruch S, Iaina A: The use of subcutaneous erythropoietin and intravenous iron for the treatment of the anemia of severe, resistant congestive heart failure improves cardiac and renal function and functional cardiac class, and markedly reduces hospitalizations. J Am Coll Cardiol 2000,35(7):1737–1744. 10.1016/S0735-1097(00)00613-6PubMedCrossRef

Nanas JN, Matsouka C, Karageorgopoulos D, Leonti A, Tsolakis E, Drakos SG, Tsagalou EP, Maroulidis GD, Alexopoulos GP, Kanakakis JE, Anastasiou-Nana MI: Etiology of anemia in patients with advanced heart failure. J Am Coll Cardiol 2006,48(12):2485–2489. 10.1016/j.jacc.2006.08.034PubMedCrossRef

Kalra PR, Anagnostopoulos C, Bolger AP: The regulation and measurement of plasma volume in heart failure. J Am Coll Cardiol 2002, 39: 1901–1908. 10.1016/S0735-1097(02)01903-4PubMedCrossRef

Anand IS, Chandrashekhar Y, Ferrari R: Pathogenesis of oedema in chronic anaemia: studies of body water and sodium, renal function, haemodynamic variables, and plasma hormones. Br Heart J 1993, 70: 357–362. 10.1136/hrt.70.4.357PubMedCentralPubMedCrossRef

Mozaffarian D, Nye R, Levy WC: Anemia predicts mortality in severe heart failure. J Am Coll Cardiol 2003, 41: 1933–1939. 10.1016/S0735-1097(03)00425-XPubMedCrossRef

Komajda M, Anker SD, Charlesworth A, Okonko D, Metra M, Di Lenarda A, Remme W, Moullet C, Swedberg K, Cleland JG, Poole-Wilson PA: The impact of new onset anaemia on morbidity and mortality in chronic heart failure: results from COMET. Eur Heart J 2006,27(12):1440–1446.PubMedCrossRef

Jankowska EA, Rozentryt P, Witkowska A, Nowak J, Hartmann O, Ponikowska B, Borodulin-Nadzieja L, Banasiak W, Polonski L, Filippatos G, McMurray JJ, Anker SD, Ponikowski P: Iron deficiency: an ominous sign in patients with systolic chronic heart failure. Eur Heart J 2010,31(15):1872–1880. 10.1093/eurheartj/ehq158PubMedCrossRef

10.

Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJ, Ponikowski P, Poole-Wilson PA, Strömberg A, van Veldhuisen DJ, Atar D, Hoes AW, Keren A, Mebazaa A, Nieminen M, Priori SG, Swedberg K, ESC Committee for Practice Guidelines (CPG): ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the task force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European society of cardiology. Developed in collaboration with the heart failure association of the ESC (HFA) and endorsed by the European society of intensive care medicine (ESICM). Eur Heart J 2008, 29: 2388–2442.PubMedCrossRef

11.

Haas JD, Brownlie T IV: Iron deficiency and reduced work capacity: a critical review of the research to determine a causal relationship. J Nutr 2001, 131: 676S-690S.PubMed

12.

Klip IT, Comin-Colet J, Voors AA, Ponikowski P, Enjuanes C, Banasiak W, Lok DJ, Rosentryt P, Torrens A, Polonski L, van Veldhuisen DJ, van der Meer P, Jankowska EA: Iron deficiency in chronic heart failure: an international pooled analysis. Am Heart J 2013,165(4):575–582. 10.1016/j.ahj.2013.01.017PubMedCrossRef

13.

Opasich C, Cazzola M, Scelsi L, De Feo S, Bosimini E, Lagioia R, Febo O, Ferrari R, Fucili A, Moratti R, Tramarin R, Tavazzi L: Blunted erythropoietin production and defective iron supply for erythropoiesis as major causes of anaemia in patients with chronic heart failure. Eur Heart J 2005, 26: 2232–2237. 10.1093/eurheartj/ehi388PubMedCrossRef

14.

Ezekowitz JA, McAlister FA, Armstrong PW: Anemia is common in heart failure and is associated with poor outcomes: insights from a cohort of 12,065 patients with new-onset heart failure. Circulation 2003, 107: 223–225. 10.1161/01.CIR.0000052622.51963.FCPubMedCrossRef

15.

Okonko DO, Grzeslo A, Witkowski T, Mandal AK, Slater RM, Roughton M, Foldes G, Thum T, Majda J, Banasiak W, Missouris CG, Poole-Wilson PA, Anker SD, Ponikowski P: Effect of intravenous iron sucrose on exercise tolerance in anemic and nonanemc patients with symptomatic chronic heart failure and iron deficiency FERRIC-HF: a randomized, controlled, observer-blinded trial. J Am Coll Cardiol 2008, 51: 103–112. 10.1016/j.jacc.2007.09.036PubMedCrossRef

16.

Anker SD, Comin Colet J, Filippatos G, Willenheimer R, Dickstein K, Drexler H, Lüscher TF, Bart B, Banasiak W, Niegowska J, Kirwan BA, Mori C, von Eisenhart RB, Pocock SJ, Poole-Wilson PA, Ponikowski P, FAIR-HF Trial Investigators: Ferric carboxymaltose in patients with heart failure and iron deficiency. N Engl J Med 2009,361(25):2436–2448. 10.1056/NEJMoa0908355PubMedCrossRef

17.

Comin-Colet J, Lainscak M, Dickstein K, Filippatos GS, Johnson P, Lüscher TF, Mori C, Willenheimer R, Ponikowski P, Anker SD: The effect of intravenous ferric carboxymaltose on health-related quality of life in patients with chronic heart failure and iron deficiency: a subanalysis of the FAIR-HF study. Eur Heart J 2013,34(1):30–38. 10.1093/eurheartj/ehr504PubMedCentralPubMedCrossRef

18.

Beck-da-Silva L, Piardi D, Soder S, Rohde LE, Pereira-Barretto AC, de Albuquerque D, Bocchi E, Vilas-Boas F, Moura LZ, Montera MW, Rassi S, Clausell N: IRON-HF study: a randomized trial to assess the effects of iron in heart failure patients with anemia. Int J Cardiol 2013,168(4):3439–3442. 10.1016/j.ijcard.2013.04.181PubMedCrossRef

19.

Gutzwiller FS, Schwenkglenks M, Blank PR, Braunhofer PG, Mori C, Szucs TD, Ponikowski P, Anker SD: Health economic assessment of ferric carboxymaltose in patients with iron deficiency and chronic heart failure based on the FAIR-HF trial: an analysis for the UK. Eur J Heart Fail 2012,14(7):782–790. 10.1093/eurjhf/hfs083PubMedCentralPubMedCrossRef

20.

Health Insurance Review and Assessment Service (HIRA), National Health Insurance Service (NHIS): 2011 national health insurance statistical yearbook. 2012.

21.

Fox M, Mealing S, Anderson R, Dean J, Stein K, Price A, Taylor RS: The clinical effectiveness and cost-effectiveness of cardiac resynchronisation (biventricular pacing) for heart failure: systematic review and economic model. Health Technol Assess 2007,11(47):iii-iv. ix-248PubMedCrossRef

22.

Kirsch J, McGuire A: Establishing health state valuations for disease specific states: an example from heart disease. Health Econ 2000, 9: 149–158. 10.1002/(SICI)1099-1050(200003)9:2<149::AID-HEC501>3.0.CO;2-NPubMedCrossRef

23.

Lewis EF, Johnson PA, Johnson W, Collins C, Griffin L, Stevenson LW: Preferences for quality of life or survival expressed by patients with heart failure. J Heart Lung Transplant 2001, 20: 1016–1024. 10.1016/S1053-2498(01)00298-4PubMedCrossRef

24.

Calvert MJ, Freemantle N, Yao G, Cleland JG, Billingham L, Daubert JC, Bryan S, CARE-HF Investigators: Cost-effectiveness of cardiac resynchronization therapy: results from the CARE-HF trial. Eur Heart J 2005, 26: 2681–2688. 10.1093/eurheartj/ehi662PubMedCrossRef

25.

Göhler A, Geisler BP, Manne JM, Kosiborod M, Zhang Z, Weintraub WS, Spertus JA, Gazelle GS, Siebert U, Cohen DJ: Utility estimates for decision-analytic modeling in chronic heart failure: health states based on New York heart association classes and number of rehospitalizations. Value Health 2009, 12: 185–187. 10.1111/j.1524-4733.2008.00425.xPubMedCrossRef

26.

Calvert MJ, Freemantle N, Cleland JG: The impact of chronic heart failure on health-related quality of life data acquired in the baseline phase of the CARE-HF study. Eur J Heart Fail 2005, 7: 243–251. 10.1016/j.ejheart.2005.01.012PubMedCrossRef

27.

Berry C, Murdoch DR, McMurray JJ: Economics of chronic heart failure. Eur J Heart Fail 2001,3(3):283–291. 10.1016/S1388-9842(01)00123-4PubMedCrossRef

28.

Ahn J, Kim Y, Shin S, Park J: Asian Study on the Value for a QALY: Korean Results. Seoul: National Evidence-based Healthcare Collaborating Agency (NECA), NECA-C-12–001; 2013.

Title: Cost-utility of ferric carboxymaltose (Ferinject®) for iron-deficiency anemia patients with chronic heart failure in South Korea
Authors: Eun-A Lim
Hyun-Soon Sohn
Haeyoung Lee
Sang-Eun Choi
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: Cost Effectiveness and Resource Allocation / Issue 1/2014
Electronic ISSN: 1478-7547
DOI: https://doi.org/10.1186/1478-7547-12-19

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Cost-utility of ferric carboxymaltose (Ferinject®) for iron-deficiency anemia patients with chronic heart failure in South Korea

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2014

The impact of incorporating Bayesian network meta-analysis in cost-effectiveness analysis - a case study of pharmacotherapies for moderate to severe COPD

Analysis of the cost-effectiveness of the implementation of Indoor Residual Spraying and distribution of Long-Lasting Insecticidal Nets in the municipality of Kouandé and municipality of Copargo in Benin

Does technique matter; a pilot study exploring weighting techniques for a multi-criteria decision support framework

Cost-effectiveness of community vegetable gardens for people living with HIV in Zimbabwe

Economic evaluation of policy initiatives in the organisation and delivery of healthcare: a case study of gastroenterology endoscopy services

Cost-effectiveness of a universal strategy of brief dietary intervention for primary prevention in primary care: population-based cohort study and Markov model