Cost Savings of Perioperative Anemia Treatment with Ferric Carboxymaltose In Colorectal Cancer Surgery Patients

Abstract

Pre-operative anemia, commonly associated with iron deficiency (IDA), occurs in approximately 30% of patients undergoing surgery. Perioperative administration of ferric carboxymaltose (FCM) was previously shown to reduce the need for red blood cell concentrate (RBC), surgical complications, mortality and the hospital length of stay (LOS) in patients with preoperative IDA. The objective of this study is to model the cost impact of peri-operative IDA treatment with FCM vs. usual care prior to colorectal cancer surgery in the French health care setting. The model used is based on the results of a RCT by Froessler et al. comparing FCM vs. usual care in abdominal surgery mostly colorectal cancer surgery patients (73% in FCM group and 85% in usual care group). Reported reduction in RBC transfusion (12.5% vs. 31.5%) and LOS (6 days vs. 9) were used as clinical metrics of the model. Cost parameters for hospitalization are based on the French Diagnostic-Related Groups (DRG) and for hospital activity on the French national hospitalizations database (PMSI). DRG were identified based on the CIM-10 diagnosis for colorectal cancer (C18). The study sample was extrapolated to a cohort size of 100 patients. The model was adapted to a Health Insurance perspective. One-way sensitivity analyses (OWSA) were undertaken. A total of 20 485 hospital stays for CRC resection were extracted from the PMSI database. Results from the model suggests that peri-operative IDA treatment with FCM reduces the overall costs in a cohort of 100 patients from € 570,373 to € 426,358, corresponding to potential savings of €144,015. Sensitivity analysis showed that LOS and cost per day in hospital ward were the main cost drivers. Peri-operative IDA treatment with FCM in CRC surgery could lead to significant cost savings based on a reduction in blood transfusion and length of stay.