Pollock Richard F, Muduma Gorden
Health Economics and Outcomes Research, Covalence Research Ltd, London, UK.
International Market Access, Pharmacosmos A/S, Holbæk, Denmark.
Clinicoecon Outcomes Res. 2021 Jan 7;13:9-18. doi: 10.2147/CEOR.S284959. eCollection 2021.
Iron deficiency anemia (IDA) is a common sequela of inflammatory bowel disease (IBD), arising from the combined effects of gastrointestinal blood loss and reduced iron absorption. Given this, intravenous (IV) iron should be considered as the first-line treatment in patients with clinically active IBD. The present study evaluated the budget impact of administering IV iron with ferric derisomaltose (FDI) versus ferric carboxymaltose (FCM) in patients with IDA and IBD in Norway, Sweden, and Finland.
A cohort level model of iron need was developed using a bivariate distribution of hemoglobin and bodyweight based on observational data from a multi-country Scandinavian study of patients with IDA and IBD. The base case analysis was conducted over 5 years in patients with IDA with mean bodyweight of 75.4 kg (SD 17.5 kg) and hemoglobin levels of 10.77 g/dL (SD 1.43 g/dL). Infusion costs were modeled using diagnosis-related groups. Sensitivity analyses were performed around different patient characteristics, care settings, and retreatment frequencies, and probabilistic sensitivity analyses were conducted.
Using FDI required 1.25 infusions to correct the mean iron deficit, compared with 1.64 infusions with FCM. In Norway, the per-patient cost of iron replenishment over 5 years was estimated to be NOK20,767 with FCM versus NOK15,799 with FDI, reflecting a cost saving of NOK4,968 or 23.9%. In Finland, costs were projected to decrease from EUR3075 with FCM to EUR2339 with FDI, reflecting a cost saving of EUR736 per patient. In Sweden, costs decreased from SEK27,760 with FCM to SEK21,119 with FDI.
Using FDI in place of FCM resulted in a substantial reduction in the number of infusions required to correct iron deficits in patients with IDA and IBD. The reduction in infusions was accompanied by substantial cost savings relative to FCM over 5 years across all three Nordic countries evaluated.
缺铁性贫血（IDA）是炎症性肠病（IBD）常见的后遗症，由胃肠道失血和铁吸收减少共同作用引起。鉴于此，静脉注射（IV）铁剂应被视为临床活动期IBD患者的一线治疗方法。本研究评估了在挪威、瑞典和芬兰，给IDA和IBD患者使用去铁胺麦芽糖铁（FDI）与羧基麦芽糖铁（FCM）进行静脉补铁的预算影响。
基于一项针对斯堪的纳维亚多国药典IDA和IBD患者的观察数据，利用血红蛋白和体重的双变量分布建立了铁需求的队列水平模型。基础病例分析在平均体重75.4千克（标准差17.5千克）、血红蛋白水平10.77克/分升（标准差1.43克/分升）的IDA患者中进行了5年。输液成本使用诊断相关组进行建模。围绕不同患者特征、护理环境和再治疗频率进行了敏感性分析，并进行了概率敏感性分析。
使用FDI纠正平均铁缺乏需要1.25次输液，而使用FCM则需要1.64次输液。在挪威，5年期间每位患者的铁补充成本估计使用FCM为20,767挪威克朗，而使用FDI为15,799挪威克朗，节省成本4,968挪威克朗，即23.9%。在芬兰，成本预计从使用FCM的3075欧元降至使用FDI的2339欧元，每位患者节省成本736欧元。在瑞典，成本从使用FCM的27,760瑞典克朗降至使用FDI的21,119瑞典克朗。
在IDA和IBD患者中，使用FDI代替FCM可显著减少纠正铁缺乏所需的输液次数。在所有三个评估的北欧国家，相对于FCM，输液次数的减少在5年内带来了可观的成本节省。
