Division of Internal Medicine, Hematology Service, Regional Hospital "A. Cardarelli,", Campobasso, Italy,
Department of Medicine and Health Sciences "V. Tiberio," University of Molise, Campobasso, Italy.
Acta Haematol. 2020;143(2):155-162. doi: 10.1159/000501329. Epub 2019 Sep 18.
Refractory anaemia (RA) among myelodysplastic syndrome (MDS) is associated with a partial functional iron deficit and may require transfusions. In low-risk lymphoma and solid tumour patients, iron support improves erythropoietin (EPO) cost-effectiveness in treating anaemia. The aim of this study is to see if oral sucrosomial iron support improves the cost-effectiveness of EPO treatment in MDS patients affected by low-risk RA. We treated patients with EPO only or with EPO plus oral sucrosomial iron or intravenous (i.v.) iron. The need for transfusions was lowest in the group taking oral iron (p = 0.016) or not receiving supplementation at all (p = 0.022). We compared costs of EPO with i.v. ferric gluconate or oral sucrosomial iron supplementation or no iron supplementation. The oral iron group had fewer side effects, fewer patient medical visits in the out-patient setting, and fewer transfusions; this led to higher savings on direct hospital costs and indirect patient costs (lost days at work) and translated into a 50% abatement of overall expenditures. EPO treatment-related expenditures in MDS-RA patients were lowest with oral sucrosomial iron supplementation (Sideral®), with a longer interval between EPO administration in maintenance treatment, quicker hemoglobin recovery, lower ferritin increase and fewer blood transfusions.
骨髓增生异常综合征（MDS）相关难治性贫血（RA）与部分功能性缺铁有关，可能需要输血。在低危淋巴瘤和实体瘤患者中，铁支持可提高促红细胞生成素（EPO）治疗贫血的成本效益。本研究旨在观察口服蔗糖铁是否能提高低危 RA 影响的 MDS 患者接受 EPO 治疗的成本效益。我们仅用 EPO 或 EPO 加口服蔗糖铁或静脉（i.v.）铁治疗患者。接受口服铁治疗（p = 0.016）或根本不接受补充治疗的患者输血需求最低（p = 0.022）。我们比较了 EPO 与 i.v. 葡聚糖铁或口服蔗糖铁补充或不补充铁的成本。口服铁组副作用较少，门诊就诊次数较少，输血较少；这导致直接医院费用和间接患者费用（工作损失天数）的节省更高，并转化为总支出减少 50%。MDS-RA 患者接受口服蔗糖铁（Sideral®）补充治疗时，EPO 治疗相关支出最低，维持治疗中 EPO 给药间隔更长，血红蛋白恢复更快，铁蛋白增加更少，输血更少。
