Cost-minimization analysis favours intravenous ferric carboxymaltose over ferric sucrose for the ambulatory treatment of severe iron deficiency

• Published in: PloS one Vol. 7; no. 9; p. e45604
• Main Authors: Calvet, Xavier, Ruíz, Miquel Àngel, Dosal, Angelina, Moreno, Laura, López, Maria, Figuerola, Ariadna, Suarez, David, Miquel, Mireia, Villoria, Albert, Gené, Emili
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 21.09.2012; Public Library of Science (PLoS)
• Subjects: Accounting; Ambulatory Care; Anemia; Anemia, Iron-Deficiency - drug therapy; Clinical trials; Computer simulation; Cost analysis; Cost engineering; Costs; Costs and Cost Analysis; Drug dosages; Drugs; Economics; Ferric Compounds - administration & dosage; Ferric Compounds - therapeutic use; Gastroenterology; Gastrointestinal diseases; Heart failure; Hospital costs; Humans; Inflammatory bowel disease; Infusions, Intravenous; Intravenous administration; Iron; Iron deficiency; Kidney diseases; Liver diseases; Maltose - administration & dosage; Maltose - analogs & derivatives; Maltose - therapeutic use; Mathematical models; Medicine; Monte Carlo Method; Monte Carlo simulation; Nutrient deficiency; Optimization; Pharmacoeconomics; Pharmacology; Regulatory agencies; Retrospective Studies; Sensitivity analysis; Simulation; Social and Behavioral Sciences; Sucrose; Sucrose - administration & dosage; Sucrose - therapeutic use; Sugar; Spain
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0045604

Intravenous iron is widely used to treat iron deficiency in day-care units. Ferric carboxymaltose (FCM) allows administration of larger iron doses than iron sucrose (IS) in each infusion (1000 mg vs. 200 mg). As FCM reduces the number of infusions required but is more expensive, we performed a cost-minimization analysis to compare the cost impact of the two drugs. The number of infusions and the iron dose of 111 consecutive patients who received intravenous iron at a gastrointestinal diseases day-care unit from 8/2007 to 7/2008 were retrospectively obtained. Costs of intravenous iron drugs were obtained from the Spanish regulatory agencies. The accounting department of the Hospital determined hospital direct and indirect costs for outpatient iron infusion. Non-hospital direct costs were calculated on the basis of patient interviews. In the pharmacoeconomic model, base case mean costs per patient were calculated for administering 1000 mg of iron per infusion using FCM or 200 mg using IS. Sensitivity analysis and Monte Carlo simulation were performed. Under baseline assumptions, the estimated cost of iron infusion per patient and year was €304 for IS and €274 for FCM, a difference of €30 in favour of FCM. Adding non-hospital direct costs to the model increased the difference to €67 (€354 for IS vs. €287 for FCM). A Monte Carlo simulation taking into account non-hospital direct costs favoured the use of FCM in 97% of simulations. In this pharmacoeconomic analysis, FCM infusion reduced the costs of iron infusion at a gastrointestinal day-care unit.