Importance of Initial Complete Parenteral Iron Repletion on Hemoglobin Level Normalization and Health Care Resource Utilization: A Retrospective Analysis

Abstract

Study Objective Iron deficiency anemia is the most common form of anemia, and parenteral iron therapy is necessary in select patients. The objective of this analysis was to assess the impact of initial complete parenteral iron repletion on serum hemoglobin (Hgb) level normalization and on health care resource utilization in real‐world practice. Design Retrospective observational study. Data Source Decision Resources Group Real‐World Data Repository (United States databases). Patients A total of 2966 patients who had a baseline Hgb level below normal (< 12 g/dl for females and < 13.5 g/dl for males) and were treated with parenteral iron between March 2015 and February 2017. Measurements and Main Results The effect of receiving the required parenteral iron dose to replete the deficit, calculated by a modified Ganzoni formula, within 3 weeks of the first parenteral iron therapy claim (index date) on the likelihood of Hgb level normalization, was estimated by using logistic regression. All analyses were adjusted for sex, age, comorbidities, and use of prescription oral iron therapy. The adjusted mean numbers of all‐cause inpatient admissions, outpatient visits, and emergency department (ED) visits within 6 months and 1 year after the index date were compared between patients with and without normalized Hgb levels by using negative binomial regression. Of the 2966 included patients, 33.9% received the required iron dose within 3 weeks of the index date, and 19.6%, 48.2%, and 53.9% had a normalized Hgb level within 8 weeks of the index date, within 1 year of the index date, and until the end of data availability, respectively. Patients who received the required iron dose within 3 weeks of the index date were significantly more likely to have a normalized Hgb level within 8 weeks of the index date and at any time during the study period than those who did not: adjusted odds ratio (OR) (95% confidence interval [CI]) 2.67 (2.20, 3.24) and 2.33 (1.96, 2.77), respectively. Hgb level normalization within 1 year of the index date was associated with fewer inpatient admissions and outpatient visits and a similar number of ED visits compared with no Hgb level normalization 1 year after the index date. Conclusion The results of these analyses underscore the importance of initial complete parenteral iron repletion for rapidly improving clinical outcomes. Prompt achievement of a normalized Hgb level may also provide an opportunity to reduce health care resource utilization in patients with iron deficiency anemia receiving parenteral iron therapy.

Effectiveness of Parenteral Iron Therapy in the Real-world Setting: A Retrospective Analysis

“…Anemia is a global public health problem that is associated with an increased risk of morbidity and mortality [3,18,19]. A previous study in US patients highlighted the importance of initial complete parenteral iron repletion for improving clinical outcomes [20], but there are limited data on realworld effectiveness of currently available parenteral iron products. This study assessed Hgb normalization with various parenteral iron products in a real-world setting using a large US database.…”

Effect of Ferric Carboxymaltose Versus Low-Dose Intravenous Iron Therapy and Iron Sucrose on the Total Cost of Care in Patients with Iron Deficiency Anemia: A US Claims Database Analysis

“…The magnitude of reductions in total cost of care was greater in patients with cancer, HF, and CKD receiving FCM versus LDI compared with the overall IV iron patient population, suggesting a higher unmet need for iron repletion in patients with chronic diseases. Patients with chronic diseases also have a greater challenge in achieving target Hgb levels than otherwise healthy patients [ 1 , 30 – 32 ]. High-dose IV iron formulations may increase the likelihood of receiving full iron replacement in patients with chronic disease and reduce subsequent healthcare resource use.…”

“…Iron deficiency is one of the most common causes of anemia. Iron is needed for many cellular functions, including erythropoiesis, and the resulting reduction in hemoglobin (Hgb) concentration due to the deficiency of iron may lead to symptoms such as fatigue, dyspnea, headache, vertigo, and worsening of comorbid diseases that are commonly associated with iron-deficiency anemia (IDA) [ 1 , 2 ]. IDA may affect a patient’s quality of life (QOL) if left untreated [ 3 ].…”

“…Current IV iron therapies available in the USA include high-dose IV iron formulations such as ferric carboxymaltose (FCM), ferumoxytol, and ferric derisomaltose, and low-dose IV iron (LDI) formulations such as iron sucrose, iron dextran, and sodium ferric gluconate complex in sucrose [ 13 ]. High-dose IV iron formulations allow patients to receive more iron with fewer infusions than LDI and have been shown to allow more patients to achieve normal serum Hgb levels than LDI [ 1 ].…”

Importance of Initial Complete Parenteral Iron Repletion on Hemoglobin Level Normalization and Health Care Resource Utilization: A Retrospective Analysis

“…In LaVallee et al 1 a paragraph in Results section was published in error. The error was due to a mislabeling of iron dose received with iron deficit during the authors’ preparation of the manuscript.…”