School of Public Health, Fudan University, Shanghai, China.
First Affiliated Hospital of Soochow University, Suzhou, China.
J Med Econ. 2022 Jan-Dec;25(1):561-570. doi: 10.1080/13696998.2022.2065092.
Two intravenous (IV) iron formulations, ferric derisomaltose (FDI) and iron sucrose (IS), are currently available for the treatment of iron deficiency anemia (IDA) in China. Clinical studies have demonstrated that FDI has an improved efficacy and safety profile versus IS, while requiring fewer infusions to correct iron deficits. Based on these findings, the present study evaluated the costs and benefits of FDI and IS for the treatment of IDA, from a healthcare system and societal perspective in China.
A patient-level model was developed to project time to hematological response and incidence of cardiovascular adverse events and hypersensitivity reactions (HSRs) associated with FDI and IS over 5 years. Costs included iron acquisition, administration, and adverse event/HSR treatment costs, based on published studies, fee schedules, and a physician survey. Health state utilities associated with adverse events, HSRs, and the number of infusions were obtained from the literature and a time trade-off survey.
From a healthcare system perspective, FDI was associated with incremental costs of RMB 1,934 (purchasing power parity USD 462) and incremental quality-adjusted life expectancy of 0.078 quality-adjusted life-years (QALYs) versus IS, yielding an incremental cost-utility ratio of RMB 24,901 (USD 5,949) in the base case scenario. From a societal perspective, FDI was associated with reduced total costs and therefore dominant versus IS.
Limitations included the absence of clinical data specific to China and insufficient data to model persistence with treatment.
This was the first cost-utility analysis comparing FDI and IS for the treatment of IDA in China. Based on a patient-level model, FDI was found to improve quality of life and reduce administration and adverse events costs relative to IS. Using the 2020 Chinese gross domestic product per capita of RMB 72,447 (USD 17,307) as a cost-effectiveness threshold, FDI would be considered cost-effective in China.
两种静脉注射（IV）铁制剂，即费利蔗糖铁（IS）和费利枸橼酸铁（FDI），目前可用于治疗中国的缺铁性贫血（IDA）。临床研究表明，FDI 相对于 IS 具有更好的疗效和安全性，同时需要更少的输注次数来纠正缺铁。基于这些发现，本研究从中国医疗保健系统和社会角度评估了 FDI 和 IS 治疗 IDA 的成本效益。
建立了一个患者水平的模型，以预测 FDI 和 IS 在 5 年内达到血液学反应和心血管不良事件（AE）及过敏反应（HSR）发生率的时间。成本包括根据已发表的研究、费用表和医生调查，获得的铁制剂获取、管理和不良反应/HSR 治疗成本。与不良反应、HSR 和输注次数相关的健康状态效用值是从文献和时间权衡调查中获得的。
从医疗保健系统的角度来看，FDI 相对于 IS 增加了人民币 1934 元（购买力平价为 462 美元）的增量成本和 0.078 个质量调整生命年（QALY）的增量质量调整生命预期，在基础情况下产生了每增加一个质量调整生命年 24901 元的增量成本-效用比（人民币，5949 美元）。从社会角度来看，FDI 与总成本的降低有关，因此相对于 IS 是具有优势的。
局限性包括缺乏针对中国的具体临床数据和治疗持久性数据不足。
这是首次在中国比较 FDI 和 IS 治疗 IDA 的成本-效用分析。基于患者水平的模型，FDI 被发现改善了生活质量，并降低了相对于 IS 的管理和不良反应成本。使用 2020 年中国人均国内生产总值（GDP）人民币 72447 元（17307 美元）作为成本效益阈值，FDI 在治疗中国的 IDA 方面具有成本效益。
