Giger Max, Achermann Rita
Institut für Pflegewissenschaften, Universität Basel.
Z Evid Fortbild Qual Gesundhwes. 2013;107(4-5):320-6. doi: 10.1016/j.zefq.2012.12.023. Epub 2013 Mar 7.
Iron anaemia and iron-deficient erythropoiesis are treated with oral iron supplements. For chronic haemodialysis or in the case of therapy failure or intolerance to oral iron therapy, intravenous supplements are administered. The costs of iron supplements borne by statutory health care insurance had strongly increased during the observation period from 2006 to 2010. Based on the invoice data of a large health insurance company with a market share of around 18 %, prescription data of iron preparations and laboratory tests were analysed and extrapolated to the Swiss population. During the 5-year observation period, costs of intravenous iron substitution increased by 16.5 m EUR (340.3 %) and the number of individuals treated by 243.5 %. A sharp rise was observed in women of menstruating age, which was mainly due to prescriptions issued by primary care physicians. More than 8 % of intravenous iron substitutions were administered without prior laboratory analysis,and must therefore be regarded as off-label use. A cost-benefit analysis is needed to demonstrate the additional value of intravenous over oral iron supplementation, and intravenous iron supplementation should be administered only to patients with proven iron deficiency.
缺铁性贫血和缺铁性红细胞生成症采用口服铁补充剂进行治疗。对于慢性血液透析患者，或在口服铁剂治疗失败或不耐受的情况下，则给予静脉补充剂。在2006年至2010年的观察期内，法定医疗保险承担的铁补充剂费用大幅增加。基于一家市场份额约为18%的大型健康保险公司的发票数据，对铁制剂的处方数据和实验室检测进行了分析，并推算至瑞士人口。在5年观察期内，静脉补铁费用增加了1650万欧元（340.3%），接受治疗的人数增加了243.5%。育龄女性的费用急剧上升，这主要是由于初级保健医生开出的处方。超过8%的静脉补铁是在没有事先进行实验室分析的情况下进行的，因此必须视为超说明书用药。需要进行成本效益分析，以证明静脉补铁相对于口服补铁的附加价值，并且静脉补铁仅应给予已证实缺铁的患者。
