静脉注射羧甲麦芽糖铁与蔗糖铁治疗成人缺铁性贫血的疗效和成本效益比较。
Efficacy and cost effectiveness of intravenous ferric carboxymaltose versus iron sucrose in adult patients with iron deficiency anaemia.
机构信息
National Center for Cancer Care and Research (NCCCR), Pharmacy Department, HMC, Doha, Qatar.
Clinical Pharmacy and Practice Department, College of Pharmacy, QU Health, Qatar University, Doha, Qatar.
出版信息
PLoS One. 2021 Aug 10;16(8):e0255104. doi: 10.1371/journal.pone.0255104. eCollection 2021.
BACKGROUND
Iron deficiency anaemia (IDA) is a major health issues and common type of nutritional deficiency worldwide. For IDA treatment, intravenous (IV) iron is a useful therapy.
OBJECTIVE
To determine the efficacy and cost-effectiveness (CE) of intravenous (IV) Ferric Carboxymaltose (FCM) versus IV Iron Sucrose (IS) in treating IDA.
DATA SOURCES
Electronic medical record i.e. Cerner® system.
TARGET POPULATION
Adults patients with iron deficiency anaemia.
TIME HORIZON
A 12-month period (01/01/2018-31/12/2018).
PERSPECTIVE
Hamad Medical Corporation (HMC, a public hospital).
INTERVENTION
IV Ferric Carboxymaltose versus IV Iron Sucrose.
OUTCOME MEASURES
With regard to responses to treatment i.e., efficacy of treatment with FCM & IS in IDA patients, hemoglobin (Hgb), ferritin, and transferrin saturation (TSAT) levels were the primary outcomes. Additionally, the researchers also collected levels of iron, platelet, white blood cell (WBC), red blood cell (RBC), mean corpuscular hemoglobin (MCH), and mean corpuscular volume (MCV). The costs i.e. resources consumed (obtained from NCCCR-HMC) and the CE of FCM versus IS were the secondary outcomes.
RESULTS OF BASE-CASE ANALYSIS: There was a significant improvement in Hgb, RBC and MCH levels in the IS group than the FCM group. The overall cost of IS therapy was significantly higher than FCM. The medication cost for FCM was approximately 6.5 times higher than IS, nonetheless, it is cheaper in terms of bed cost and nursing cost. The cost effectiveness (CE) ratio illustrated that FCM and IS were significantly different in terms of Hgb, ferritin and MCH levels. Further, Incremental Cost Effectiveness Ratio (ICER) indicated that further justifications and decisions need to be made for FCM when using Hgb, iron, TSAT, MCH and MCV levels as surrogate outcomes.
RESULTS OF SENSITIVITY ANALYSIS
Not applicable.
LIMITATIONS
The study did not consider the clinical or humanistic outcome.
CONCLUSIONS
The higher cost of FCM versus IS can be offset by savings in healthcare personnel time and bed space. ICER indicated that further justifications and decisions need to be made for FCM when using Hgb, iron, TSAT, MCH and MCV levels as surrogate outcomes.
背景
缺铁性贫血（IDA）是全球范围内的一个主要健康问题和常见的营养缺乏类型。对于 IDA 的治疗，静脉内（IV）铁是一种有用的治疗方法。
目的
确定静脉内（IV）羧基麦芽糖铁（FCM）与静脉内铁蔗糖（IS）治疗 IDA 的疗效和成本效益（CE）。
数据来源
电子病历，即 Cerner®系统。
目标人群
患有缺铁性贫血的成年患者。
时间范围
12 个月（2018 年 1 月 1 日至 2018 年 12 月 31 日）。
视角
哈马德医疗保健公司（HMC，一家公立医院）。
干预措施
静脉内羧基麦芽糖铁与静脉内铁蔗糖。
结果测量
就治疗反应而言，即 FCM 和 IS 治疗 IDA 患者的疗效，血红蛋白（Hgb）、铁蛋白和转铁蛋白饱和度（TSAT）水平是主要结果。此外，研究人员还收集了铁、血小板、白细胞（WBC）、红细胞（RBC）、平均红细胞血红蛋白（MCH）和平均红细胞体积（MCV）的水平。FCM 与 IS 的成本，即消耗的资源（从 NCCCR-HMC 获得）和 CE 是次要结果。
基础分析结果
IS 组的 Hgb、RBC 和 MCH 水平明显高于 FCM 组。IS 治疗的总体成本明显高于 FCM。FCM 的药物成本约为 IS 的 6.5 倍，但在床位成本和护理成本方面更便宜。成本效益（CE）比表明，FCM 和 IS 在 Hgb、铁和 MCH 水平方面存在显著差异。此外，增量成本效益比（ICER）表明，当使用 Hgb、铁、TSAT、MCH 和 MCV 水平作为替代结果时，需要进一步为 FCM 做出理由和决策。
敏感性分析结果
不适用。
局限性
该研究未考虑临床或人文结果。
结论
FCM 与 IS 的较高成本可以通过节省医疗保健人员的时间和床位空间来抵消。ICER 表明，当使用 Hgb、铁、TSAT、MCH 和 MCV 水平作为替代结果时，需要进一步为 FCM 做出理由和决策。
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