Evaluation of the Cost-Effectiveness of Iron Formulations for the Treatment of Iron Deficiency Anaemia in Patients with Inflammatory Bowel Disease in the UK

Abstract

Introduction In patients with inflammatory bowel disease (IBD), iron deficiency anaemia (IDA) can impair quality of life and increase healthcare costs. Treatment options for IDA-associated IBD include oral iron and intravenous iron formulations (such as ferric carboxymaltose [FCM], ferric derisomaltose [FD, previously known as iron isomaltoside 1000], and iron sucrose [IS]). The present analysis compared the cost-effectiveness of FCM versus FD, IS, and oral iron sulfate in terms of additional cost per additional responder in the UK setting. Methods Cost-effectiveness was calculated for FCM versus FD, IS, and oral iron individually in terms of the additional cost per additional responder, defined as haemoglobin normalisation or an increase of ≥2 g/dL in haemoglobin levels, in a model developed in Microsoft Excel. Relative efficacy inputs were taken from a previously published network meta-analysis, since there is currently no single head-to-head trial evidence comparing all therapy options. Costs were calculated in 2020 pounds sterling (GBP) capturing the costs of iron preparations, healthcare professional time, and consumables. Results The analysis suggested that FCM may be the most effective intervention, with 81% of patients achieving a response. Response rates with FD, IS, and oral iron were 74%, 75%, and 69%, respectively. Total costs with FCM, FD, IS, and oral iron were GBP 296, GBP 312, GBP 503, and GBP 56, respectively. FCM was found to be more effective and less costly than both FD and IS, and therefore was considered dominant. Compared with oral iron, FCM was associated with an incremental cost-effectiveness ratio of GBP 2045 per additional responder. Conclusions FCM is likely to be the least costly and most effective IV iron therapy in the UK setting. Compared with oral iron, healthcare payers must decide whether the superior treatment efficacy of FCM is worth the additional cost.

Iron Deficiency Anemia in Inflammatory Bowel Diseases—A Narrative Review

“…Their multifactorial etiopathogenesis has not been clearly defined to date. They include, among others, immunological background, genetic, and environmental factors [1,2].…”

Cost-Effectiveness of Intravenous Iron Formulations in Patients with Iron Deficiency Anaemia and Inflammatory Bowel Disease, in a Swedish Regional Setting Using Real-World Tender Prices

“…Model projections were limited to a 1-year time horizon, meaning that outcomes were not discounted. The underlying model has previously been published by Aksan et al for similar calculations of the cost per responder in the Swiss and UK national settings [25,26] but was restructured to meet the scope of this study, in the Swedish regional setting.…”

“…A CEA of FD vs. FCM in the UK found that haematological response was 9% higher in patients treated with FD than with FCM [24]. On the other hand, two separate analyses of FCM vs. FD and IS in Switzerland and the UK estimated that, in terms of costeffectiveness, FCM was both more effective and less costly for the respective health-care systems [25,26]. In the Nordic context, a 2018 economic evaluation of FD vs. FCM was conducted in the Danish setting, followed by another economic evaluation in 2021, which used data for patients in Norway, Sweden, and Denmark.…”

Management of iron‐deficiency anemia following acute gastrointestinal hemorrhage: A narrative analysis and review

“…While there have been evaluations of the cost-effectiveness of different iron therapies in patients with IDA, [26][27][28][29] we are unaware of any such analyses specifically in the context of acute GIB-related ID/IDA. Delays in the administration of iron replacement are common and likely impact both direct medical costs and indirect costs in terms of the negative effect on the patient's QoL and productivity losses.…”