Pharmacoeconomic analysis of different intravenous iron replacement therapies

[Speaker] Vlasta Orsic Fric:1,2
[Co-author] Vladimir Borzan:1,2, Biljana Borzan:2
1:Department of Gastroenterology and Hepatology, Clinical Hospital Center Osijek, Croatia, 2:Faculty of Medicine, J. J. Strossmayer University of Osijek, Croatia

Iron-deficiency anaemia develops in various gastrointestinal conditions. In patients with severe anaemia or intolerance to oral iron, treatment with intravenous iron is indicated.
Our aim was to compare costs of iron replacement therapy (IRT) with new intravenous iron preparations and sodium ferric gluconate (SFG) in patients treated at our day-care unit.

We collected data (age, preparation used, total dose of iron, number of infusions) on patients who received either ferric carboxymaltose (FCM) or iron III isomaltoside (IIM) in our day-care unit from October 2016 till March 2017.
Costs of therapy were divided on costs of preparation together with infusion-related costs, costs of personnel and non-hospital costs (time off-work).
Prices of the drug and infusion-related materials were obtained from hospital pharmacy. Nurse working hours were calculated as minimal time needed for infusion plus 15 min per visit for infusion preparation. Patients from 18-65 years were considered as working active. Cost of off-work day was calculated as 70% of average daily salary in Croatia plus daily salary for a replacement.
Total calculated costs of therapy with FCM and IIM were compared to projected costs of therapy with SFG for same number of patients with equivalent dose of iron.

During 6 months, 86 patients received 230 vials of either FCM or IIM. If the same number of patients received the equivalent dose of iron as SFG, costs of the drug together with infusion related costs would be 5.2 times lower. On the other hand, with SFG therapy number of infusions would be 13.5 times greater with 18.7 times more nurse working hours needed. Considering higher number of infusions on SFG therapy, costs of off-work days would be 14.1 times greater for 49 working active patients.

SFG is less expensive than FCM and IIM when considering only drug price and therefore often considered as preferred therapy from the aspect of hospital and department management. Our aim was to show that all relevant costs such as costs of personnel and time off-work should be taken into account when considering different IRTs. Overall costs of IRT support the use of new preparations.

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