Efficacy and cost effectiveness of intravenous ferric carboxymaltose versus iron sucrose in adult patients with iron deficiency anaemia.

Rami Abumousa,Mahmood B Aldapt,Ahmad A Adel,Mohamed Abdul Jaber Abdullah,Radwa M Hussein,Nabil E Omar,Mohamed Izham Mohamed Ibrahim,Ahmad Basha,Anas Hamad,Yaslem Ekeibed,Hawraa M Shwaylia,Ahmed Mahfouz,Mohamed A Yassin,Prem Chandra

doi:10.1371/journal.pone.0255104

Abstract

Iron deficiency anaemia (IDA) is a major health issues and common type of nutritional deficiency worldwide. For IDA treatment, intravenous (IV) iron is a useful therapy. To determine the efficacy and cost-effectiveness (CE) of intravenous (IV) Ferric Carboxymaltose (FCM) versus IV Iron Sucrose (IS) in treating IDA. Electronic medical record i.e. Cerner® system. Adults patients with iron deficiency anaemia. A 12-month period (01/01/2018-31/12/2018). Hamad Medical Corporation (HMC, a public hospital). IV Ferric Carboxymaltose versus IV Iron Sucrose. With regard to responses to treatment i.e., efficacy of treatment with FCM & IS in IDA patients, hemoglobin (Hgb), ferritin, and transferrin saturation (TSAT) levels were the primary outcomes. Additionally, the researchers also collected levels of iron, platelet, white blood cell (WBC), red blood cell (RBC), mean corpuscular hemoglobin (MCH), and mean corpuscular volume (MCV). The costs i.e. resources consumed (obtained from NCCCR-HMC) and the CE of FCM versus IS were the secondary outcomes. There was a significant improvement in Hgb, RBC and MCH levels in the IS group than the FCM group. The overall cost of IS therapy was significantly higher than FCM. The medication cost for FCM was approximately 6.5 times higher than IS, nonetheless, it is cheaper in terms of bed cost and nursing cost. The cost effectiveness (CE) ratio illustrated that FCM and IS were significantly different in terms of Hgb, ferritin and MCH levels. Further, Incremental Cost Effectiveness Ratio (ICER) indicated that further justifications and decisions need to be made for FCM when using Hgb, iron, TSAT, MCH and MCV levels as surrogate outcomes. Not applicable. The study did not consider the clinical or humanistic outcome. The higher cost of FCM versus IS can be offset by savings in healthcare personnel time and bed space. ICER indicated that further justifications and decisions need to be made for FCM when using Hgb, iron, TSAT, MCH and MCV levels as surrogate outcomes.

Highlights

Iron is the most common nutritional deficiency worldwide, especially in developing countries which can lead to anaemia [1]
Incremental Cost Effectiveness Ratio (ICER) indicated that further justifications and decisions need to be made for Ferric Carboxymaltose (FCM) when using Hgb, iron, transferrin saturation (TSAT), mean corpuscular hemoglobin (MCH) and mean corpuscular volume (MCV) levels as surrogate outcomes
The WHO reports have demonstrated that anaemia affects 1.59 billion people, which constitutes to 24% of the total population [2]

Summary

Introduction

Iron is the most common nutritional deficiency worldwide, especially in developing countries which can lead to anaemia [1]. Iron deficiency anaemia (IDA) represents the most prevailing kind of anaemia worldwide, and it is accompanied by depleted iron stores and signs of a compromised supply of iron to the tissues which may include fatigue, pale skin, chest pain, headache, and dizziness [4]. Oral iron supplementation indicated quite promising results in increasing hemoglobin levels, gastrointestinal side effects like nausea, constipation, gastritis are likely to affect compliance in a high percentage of patients [6]. Iron deficiency anaemia (IDA) is a major health issues and common type of nutritional deficiency worldwide. For IDA treatment, intravenous (IV) iron is a useful therapy

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