A budget impact analysis of parenteral iron treatments for iron deficiency anemia in the UK: reduced resource utilization with iron isomaltoside 1000

Richard F Pollock, Gorden Muduma, Richard F Pollock, Gorden Muduma

Abstract

Background and aims: The reported prevalence of iron deficiency anemia (IDA) varies widely but estimates suggest that 3% of men and 8% of women have IDA in the UK. Parenteral iron is indicated for patients intolerant or unresponsive to oral iron or requiring rapid iron replenishment. This study evaluated differences in the cost of treating these patients with iron isomaltoside (Monofer®, IIM) relative to other intravenous iron formulations.

Methods: A budget impact model was developed to evaluate the cost of using IIM relative to ferric carboxymaltose (Ferinject®, FCM), low molecular weight iron dextran (Cosmofer®, LMWID), and iron sucrose (Venofer®, IS) in patients with IDA. To establish iron need, iron deficits were modeled using a simplified dosing table. The base case analysis was conducted over 1 year in patients with IDA with mean bodyweight of 82.4 kg (SD 22.5 kg) and hemoglobin levels of 9.99 g/dL (SD 1.03 g/dL) based on an analysis of patient characteristics in IDA trials. Costs were modeled using UK health care resource groups.

Results: Using IIM required 1.3 infusions to correct the mean iron deficit, compared with 1.3, 1.8, and 7.7 with LMWID, FCM, and IS, respectively. Patients using IIM required multiple infusions in 35% of cases, compared with 35%, 77%, and 100% of patients with LMWID, FCM, and IS, respectively. Total costs were estimated to be GBP 451 per patient with IIM or LMWID, relative to GBP 594 with FCM (a GBP 143 or 24% saving with IIM) or GBP 2,600 with IS (a GBP 2,149 or 83% saving with IIM).

Conclusion: Using IIM or LMWID in place of FCM or IS resulted in a marked reduction in the number of infusions required to correct iron deficits in patients with IDA. The reduction in infusions was accompanied by substantial reductions in cost relative to FCM and IS over 1 year.

Keywords: Great Britain; administration; costs and cost analysis; intravenous; iron; iron deficiency anemia.

Conflict of interest statement

Disclosure Gorden Muduma is a full-time employee of Pharmacosmos A/S, the EU marketing authorization holder for Monofer® (IIM) and Cosmofer® (LMWID). Richard Pollock is a full-time employee of Ossian Health Economics and Communications GmbH, which received consultancy fees from Pharmacosmos A/S to develop the budget impact model and conduct the analysis. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Histograms of bodyweight and hemoglobin distributions in the base case analysis illustrated using a bodyweight bin size of 1 kg (A) and a hemoglobin bin size of 0.5 g/dL (B).
Figure 2
Figure 2
Mean number of infusions per patient (A) and proportion of patients requiring multiple infusions (B).
Figure 3
Figure 3
Cost savings with iron isomaltoside relative to iron sucrose (A) and ferric carboxymaltose (B) over a range of mean bodyweights in an average clinical commissioning group. Abbreviation: GBP, 2016 pounds sterling.

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