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Bjorner JB, Kennedy N, Lindgren S, Pollock RF. Hypophosphatemia attenuates improvements in vitality after intravenous iron treatment in patients with inflammatory bowel disease. Qual Life Res 2024; 33:2285-2294. [PMID: 38874697 PMCID: PMC11286717 DOI: 10.1007/s11136-024-03642-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 06/15/2024]
Abstract
PURPOSE Iron deficiency anemia is common in people with inflammatory bowel disease (IBD), causing deterioration in quality of life, which can be reversed by treatment that increases iron stores and hemoglobin levels. The present post hoc analyses estimate health state utility values for patients with IBD after treatment with ferric derisomaltose or ferric carboxymaltose and evaluate the health domains driving the changes. METHODS SF-36v2 responses were recorded at baseline and day 14, 35, 49, and 70 from 97 patients enrolled in the randomized, double-blind, PHOSPHARE-IBD trial (ClinicalTrials.gov ID: NCT03466983), in which patients with IBD across five European countries were randomly allocated to either ferric derisomaltose or ferric carboxymaltose. Changes in SF-36v2 scale scores and SF-6Dv2 health utility values were analyzed by mixed models. RESULTS In both treatment arms, SF-6Dv2 utility values and all SF-36v2 scale scores, except Bodily Pain, improved significantly (p = < 0.0001). The improvement in SF-6Dv2 utility values showed no significant treatment group difference. The improvement in utility values was completely explained by improvement in Vitality scores. Vitality scores showed significantly larger improvement with ferric derisomaltose versus ferric carboxymaltose (p = 0.026). Patients with the smallest decrease in phosphate had significantly larger improvements in Vitality scores at each time point (p = < 0.05 for all comparisons) and overall (p = 0.0006). CONCLUSIONS Utility values improved significantly with intravenous iron treatment. Improvement in utility values was primarily driven by Vitality scores, which showed significantly greater improvement in the ferric derisomaltose arm. Smaller decreases in phosphate were associated with significantly higher Vitality scores, suggesting that quality of life improvement is attenuated by hypophosphatemia. The utility values can inform future cost-utility analysis.
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Affiliation(s)
- J B Bjorner
- QualityMetric Incorporated LLC, Johnston, RI, USA
| | - N Kennedy
- Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - S Lindgren
- Department of Gastroenterology and Hepatology, Skåne University Hospital Malmö, Lund University, Lund, Sweden
| | - R F Pollock
- Covalence Research Ltd, Rivers Lodge, West Common, Harpenden, AL5 2JD, UK.
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2
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Hansen LT, Riis J, Kragholm KH, Larsen LK, Cavallius C, Mørch MM, Clemmensen SZ, Krogager ML, Melgaard D. Impact of postoperative intravenous iron therapy on postoperative infections in older patients with severe anaemia after hip fracture surgery. BMC Geriatr 2023; 23:95. [PMID: 36788483 PMCID: PMC9930316 DOI: 10.1186/s12877-023-03775-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 01/27/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Anaemia is common following hip fracture in ortho-geriatric patients and is associated with postoperative infections.. This study investigated whether intravenous iron supplements reduced the rate of postoperative infections within 30 days postoperatively in older adults after hip fracture surgery. METHODS This observational study included 198 ortho-geriatric patients July 2018-May 2020. In May 2019 a local guideline was implemented and recommended II therapy on the 3rd postoperative day if haemoglobin concentration was < 6.5 mmol/L after hip fracture surgery. RESULTS The patients were divided into four treatment groups: blood transfusion (n = 44), IV iron (n = 69), blood transfusion + IV iron (n = 35) and no treatment (n = 50). The number of patients who had an infection within 30 days was similar in the two time periods (38.8% before vs. 38.9% after systematic I.V. iron supplementation, P = 1.00) and no significant difference according to risk of infection was found between treatment groups. CONCLUSION This study documents no effect of intravenous iron supplements on postoperative infections in older adults after hip fracture surgery. TRIAL REGISTRATION The study was registered with the Danish Data Protection Authority (2008-58-0028) the 2th of September 2019.
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Affiliation(s)
- Lene T. Hansen
- Department of Geriatric Medicine, North Denmark Regional Hospital, Hjørring, Denmark
| | | | - Kristian H. Kragholm
- North Denmark Regional Hospital, Hjørring, Denmark ,grid.27530.330000 0004 0646 7349Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Aalborg, Denmark ,grid.27530.330000 0004 0646 7349Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Lis K. Larsen
- grid.27530.330000 0004 0646 7349Department of Orthopedic Surgery, Aalborg University Hospital, Hjørring, Denmark
| | - Christian Cavallius
- grid.27530.330000 0004 0646 7349Department of Orthopedic Surgery, Aalborg University Hospital, Hjørring, Denmark
| | - Marianne M. Mørch
- Department of Geriatric Medicine, North Denmark Regional Hospital, Hjørring, Denmark
| | - Silas Z. Clemmensen
- North Denmark Regional Hospital, Hjørring, Denmark ,grid.27530.330000 0004 0646 7349Department of Orthopedic Surgery, Aalborg University Hospital, Hjørring, Denmark
| | - Maria L. Krogager
- grid.27530.330000 0004 0646 7349Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark ,grid.27530.330000 0004 0646 7349Department of Emergency Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Dorte Melgaard
- North Denmark Regional Hospital, Hjørring, Denmark. .,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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3
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Auerbach M, Achebe MM, Thomsen LL, Derman RJ. Efficacy and safety of ferric derisomaltose (FDI) compared with iron sucrose (IS) in patients with iron deficiency anemia after bariatric surgery. Obes Surg 2022; 32:810-818. [PMID: 35000068 PMCID: PMC8866325 DOI: 10.1007/s11695-021-05858-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 11/30/2022]
Abstract
Purpose Iron deficiency is common following bariatric surgery, and treatment with intravenous iron is often required. This post hoc analysis of data from two randomized, open-label, multicenter trials evaluated the efficacy and safety of ferric derisomaltose (FDI; formerly iron isomaltoside 1000) versus iron sucrose (IS) over 4 weeks in adults with iron deficiency anemia (IDA) resulting from prior bariatric surgery. Materials and methods Data were pooled for participants who received FDI or IS in the PROVIDE or FERWON-IDA trials for the treatment of IDA post bariatric surgery. Efficacy outcomes included changes in hemoglobin (Hb) and iron parameters; safety outcomes included the incidence of adverse drug reactions (ADRs), serious or severe hypersensitivity reactions (HSRs), and hypophosphatemia. Results The analysis included 159 patients. Mean (standard deviation) cumulative iron doses were 1199 (± 347) mg for FDI and 937 (± 209) mg for IS. Compared with IS, FDI resulted in a faster and more pronounced Hb response, and a higher proportion of responders (Hb level increase ≥ 2 g/dL from baseline) at all time points. The incidence of ADRs was similar with FDI and IS (15.1% and 18.2%, respectively), with no serious ADRs or serious or severe HSRs reported. The incidence of hypophosphatemia was low and similar in both treatment groups, with no cases of severe hypophosphatemia observed. Conclusions In patients with IDA resulting from bariatric surgery, FDI produced a faster and more pronounced Hb response than IS. Both FDI and IS were well tolerated. Graphical abstract ![]()
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Affiliation(s)
- Michael Auerbach
- Department of Medicine, Georgetown University School of Medicine, Washington, DC, USA.
| | - Maureen M Achebe
- Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Lars L Thomsen
- Department of Clinical and Non-Clinical Research, Pharmacosmos A/S, Holbæk, Denmark
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4
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Muñoz M, Reinisch W. Letter to the Editor Regarding 'Iron Formulations for the Treatment of Iron Deficiency Anemia in Patients with Inflammatory Bowel Disease: A Cost-Effectiveness Analysis in Switzerland'. Adv Ther 2022; 39:811-814. [PMID: 34846707 PMCID: PMC8799545 DOI: 10.1007/s12325-021-02000-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 11/16/2021] [Indexed: 12/15/2022]
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5
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Aksan A, Beales ILP, Baxter G, de Arellano AR, Gavata S, Valentine WJ, Hunt B. Evaluation of the Cost-Effectiveness of Iron Formulations for the Treatment of Iron Deficiency Anaemia in Patients with Inflammatory Bowel Disease in the UK. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:541-552. [PMID: 34168471 PMCID: PMC8216635 DOI: 10.2147/ceor.s306823] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/06/2021] [Indexed: 12/21/2022] Open
Abstract
Introduction In patients with inflammatory bowel disease (IBD), iron deficiency anaemia (IDA) can impair quality of life and increase healthcare costs. Treatment options for IDA-associated IBD include oral iron and intravenous iron formulations (such as ferric carboxymaltose [FCM], ferric derisomaltose [FD, previously known as iron isomaltoside 1000], and iron sucrose [IS]). The present analysis compared the cost-effectiveness of FCM versus FD, IS, and oral iron sulfate in terms of additional cost per additional responder in the UK setting. Methods Cost-effectiveness was calculated for FCM versus FD, IS, and oral iron individually in terms of the additional cost per additional responder, defined as haemoglobin normalisation or an increase of ≥2 g/dL in haemoglobin levels, in a model developed in Microsoft Excel. Relative efficacy inputs were taken from a previously published network meta-analysis, since there is currently no single head-to-head trial evidence comparing all therapy options. Costs were calculated in 2020 pounds sterling (GBP) capturing the costs of iron preparations, healthcare professional time, and consumables. Results The analysis suggested that FCM may be the most effective intervention, with 81% of patients achieving a response. Response rates with FD, IS, and oral iron were 74%, 75%, and 69%, respectively. Total costs with FCM, FD, IS, and oral iron were GBP 296, GBP 312, GBP 503, and GBP 56, respectively. FCM was found to be more effective and less costly than both FD and IS, and therefore was considered dominant. Compared with oral iron, FCM was associated with an incremental cost-effectiveness ratio of GBP 2045 per additional responder. Conclusions FCM is likely to be the least costly and most effective IV iron therapy in the UK setting. Compared with oral iron, healthcare payers must decide whether the superior treatment efficacy of FCM is worth the additional cost.
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Affiliation(s)
- Aysegül Aksan
- Interdisciplinary Crohn Colitis Centre, Rhein-main, Frankfurt/Main, Germany.,Institute of Nutritional Science, Justus-Liebig University, Giessen, Germany
| | - Ian L P Beales
- Department of Gastroenterology, Norfolk and Norwich University Hospital, Norwich, UK
| | | | | | - Simona Gavata
- Vifor Pharma Group, Market Access, Glattbrugg, Switzerland
| | | | - Barnaby Hunt
- Ossian Health Economics and Communications, Basel, Switzerland
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6
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Clemmensen SZ, Kragholm KH, Melgaard D, Hansen LT, Riis J, Cavallius C, Mørch MM, Krogager ML. Association between intravenous iron therapy and short-term mortality risk in older patients undergoing hip fracture surgery: an observational study. J Orthop Surg Res 2021; 16:320. [PMID: 34006287 PMCID: PMC8130414 DOI: 10.1186/s13018-021-02462-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/06/2021] [Indexed: 12/22/2022] Open
Abstract
Background Anemia is common among ortho-geriatric hip fracture patients and is associated with prolonged recovery and increased postoperative mortality rate. Intravenous iron seems to increase hemoglobin recovery and reduce the mortality rate in patients undergoing orthopedic surgeries. This study investigated the association between short-term mortality risk and intravenous iron therapy in older patients undergoing hip fracture surgery. Methods This observational study included 210 patients undergoing hip fracture surgery from July 2018 to May 2020. These 210 patients were alive and had a hemoglobin ≤ 6.5 mmol/L on the 3rd postoperative day. In May 2019, a local intravenous iron therapy protocol was implemented and recommended intravenous iron (Monofer©) if hemoglobin on the 3rd postoperative day was ≤ 6.5 mmol/L. According to the treatment of postoperative anemia between the 1st and 3rd day post-surgery, the patients were divided into four groups: no treatment (n=52), blood transfusion (n=38), IV Monofer (n=80), and blood transfusion and IV Monofer (n=40). Primary outcome was 30-day mortality post-surgery. The secondary outcome was the impact on hemoglobin level 14–30 days postoperatively. Multivariable Cox regression was used to estimate the 30-day mortality standardized for covariates. Results Of 210 patients, 17 (8.1%) died within 30 days after surgery. There was a significantly lower mortality among the patients who received IV Monofer compared to those who received no treatment (HR 0.17, 95% CI [0.03–0.93], P = 0.041). Among the 86 patients with available hemoglobin measurements within 14 to 30 days post-surgery, there was no significant difference in hemoglobin level between the various treatment groups (mean 6.6 mmol/L, P = 0.1165). Conclusion IV Monofer on the 3rd postoperative day in older hip fracture patients seemed to reduce 30-day mortality compared with no treatment. No significant differences in hemoglobin levels between 14 and 30 days post-surgery across treatment groups were found, although this was assessed in a subset of patients with available hemoglobin levels warranting further study. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02462-x.
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Affiliation(s)
- Silas Zacharias Clemmensen
- Center for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark. .,Department of Orthopedic Surgery, Aalborg University Hospital, Hjørring, Denmark.
| | - Kristian H Kragholm
- Center for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark.,Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Dorte Melgaard
- Center for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Lene T Hansen
- Department of Geriatric Medicine, North Denmark Regional Hospital, Hjørring, Denmark
| | - Johannes Riis
- Center for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark
| | - Christian Cavallius
- Department of Orthopedic Surgery, Aalborg University Hospital, Hjørring, Denmark
| | - Marianne M Mørch
- Department of Geriatric Medicine, North Denmark Regional Hospital, Hjørring, Denmark
| | - Maria Lukács Krogager
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Emergency Medicine, Aalborg University Hospital, Aalborg, Denmark
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7
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Pollock RF, Muduma G. An Economic Analysis of Ferric Derisomaltose versus Ferric Carboxymaltose in the Treatment of Iron Deficiency Anemia in Patients with Inflammatory Bowel Disease in Norway, Sweden, and Finland. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:9-18. [PMID: 33442276 PMCID: PMC7800446 DOI: 10.2147/ceor.s284959] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 11/25/2020] [Indexed: 12/29/2022] Open
Abstract
Background and Aims Iron deficiency anemia (IDA) is a common sequela of inflammatory bowel disease (IBD), arising from the combined effects of gastrointestinal blood loss and reduced iron absorption. Given this, intravenous (IV) iron should be considered as the first-line treatment in patients with clinically active IBD. The present study evaluated the budget impact of administering IV iron with ferric derisomaltose (FDI) versus ferric carboxymaltose (FCM) in patients with IDA and IBD in Norway, Sweden, and Finland. Methods A cohort level model of iron need was developed using a bivariate distribution of hemoglobin and bodyweight based on observational data from a multi-country Scandinavian study of patients with IDA and IBD. The base case analysis was conducted over 5 years in patients with IDA with mean bodyweight of 75.4 kg (SD 17.5 kg) and hemoglobin levels of 10.77 g/dL (SD 1.43 g/dL). Infusion costs were modeled using diagnosis-related groups. Sensitivity analyses were performed around different patient characteristics, care settings, and retreatment frequencies, and probabilistic sensitivity analyses were conducted. Results Using FDI required 1.25 infusions to correct the mean iron deficit, compared with 1.64 infusions with FCM. In Norway, the per-patient cost of iron replenishment over 5 years was estimated to be NOK20,767 with FCM versus NOK15,799 with FDI, reflecting a cost saving of NOK4,968 or 23.9%. In Finland, costs were projected to decrease from EUR3075 with FCM to EUR2339 with FDI, reflecting a cost saving of EUR736 per patient. In Sweden, costs decreased from SEK27,760 with FCM to SEK21,119 with FDI. Conclusion Using FDI in place of FCM resulted in a substantial reduction in the number of infusions required to correct iron deficits in patients with IDA and IBD. The reduction in infusions was accompanied by substantial cost savings relative to FCM over 5 years across all three Nordic countries evaluated.
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Affiliation(s)
- Richard F Pollock
- Health Economics and Outcomes Research, Covalence Research Ltd, London, UK
| | - Gorden Muduma
- International Market Access, Pharmacosmos A/S, Holbæk, Denmark
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8
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Kassianides X, Bodington R, Bhandari S. An evaluation of ferric derisomaltose as a treatment for anemia. Expert Rev Hematol 2020; 14:7-29. [PMID: 33317356 DOI: 10.1080/17474086.2021.1858406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Introduction: Originally approved in Europe in 2009, ferric derisomaltose is the most recently authorized intravenous iron compound in the United States of America (2020). Ferric derisomaltose given as a rapid high-dose infusion can allow complete iron repletion in a single dose and it is now widely used in the treatment of iron deficiency. Areas covered: The chemistry, pharmacodynamics and pharmacokinetics of ferric derisomaltose are reviewed. Results from phase II, III and IV trials regarding efficacy and safety are presented. Mechanisms behind minor infusion reactions, hypersensitivity and hypophosphatemia are discussed. The economic impact of ferric derisomaltose use is presented. Data pertaining to the use of ferric derisomaltose in iron deficiency anemia, chronic kidney disease, inflammatory bowel disease, chronic heart failure, perioperative care and other patient groups are comprehensively covered. Expert opinion: Ferric derisomaltose is an effective intravenous iron formulation with a good safety profile, providing rapid, cost-effective iron repletion. Ferric derisomaltose releases low quantities of labile iron relative to older compounds. Anaphylaxis is extremely rare, and 'Fishbane' reactions are uncommon. Hypophosphatemia following ferric derisomaltose administration is infrequent in comparison to other intravenous irons such as ferric carboxymaltose. The scope of ferric derisomaltose use is growing with increasing research in these areas.
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Affiliation(s)
- Xenophon Kassianides
- Academic Renal Department, Hull University Teaching Hospitals NHS Trust and Hull York Medical School , Hull, UK
| | - Richard Bodington
- Academic Renal Department, Hull University Teaching Hospitals NHS Trust and Hull York Medical School , Hull, UK
| | - Sunil Bhandari
- Academic Renal Department, Hull University Teaching Hospitals NHS Trust and Hull York Medical School , Hull, UK
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9
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Kalra PA, Bhandari S, Spyridon M, Davison R, Lawman S, Mikhail A, Reaich D, Pritchard N, McCafferty K, Moore J. NIMO-CKD-UK: a real-world, observational study of iron isomaltoside in patients with iron deficiency anaemia and chronic kidney disease. BMC Nephrol 2020; 21:539. [PMID: 33302891 PMCID: PMC7726614 DOI: 10.1186/s12882-020-02180-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 11/19/2020] [Indexed: 12/21/2022] Open
Abstract
Background Intravenous iron is often used to treat iron deficiency anaemia in non-dialysis chronic kidney disease (ND-CKD), but the optimal dosing regimen remains unclear. We evaluated the impact of high- versus low-dose intravenous iron isomaltoside on the probability of retreatment with intravenous iron in iron-deficient ND-CKD patients. Methods This real-world, prospective, observational study collected data from 256 ND-CKD patients treated for anaemia in the UK. Following an initial course of iron isomaltoside, patients were followed for ≥12 months. Iron dose and the need for retreatment were determined at the investigators’ discretion. The primary study outcome was the need for retreatment at 52 weeks compared between patients who received >1000 mg of iron during Course 1 and those who received ≤1000 mg. Safety was evaluated through adverse drug reactions. Results The probability of retreatment at Week 52 was significantly lower in the >1000 mg iron group (n = 58) versus the ≤1000 mg group (n = 198); hazard ratio (95% confidence interval [CI]): 0.46 (0.20, 0.91); p = 0.012. Mean (95% CI) haemoglobin increased by 6.58 (4.94, 8.21) g/L in the ≤1000 mg group and by 10.59 (7.52, 13.66) g/L in the >1000 mg group (p = 0.024). Changes in other blood and iron parameters were not significantly different between the two groups. Administering >1000 mg of iron isomaltoside saved 8.6 appointments per 100 patients compared to ≤1000 mg. No serious adverse drug reactions were reported. Of the patients who received ≤1000 mg of iron in this study, 82.3% were eligible for a dose >1000 mg. Conclusions The >1000 mg iron isomaltoside regimen reduced the probability of retreatment, achieved a greater haemoglobin response irrespective of erythropoiesis-stimulating agent treatment, and reduced the total number of appointments required, compared to the ≤1000 mg regimen. Many of the patients who received ≤1000 mg of iron were eligible for >1000 mg, indicating that there was considerable underdosing in this study. Trial registration ClinicalTrials.gov NCT02546154, 10 September 2015.
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Affiliation(s)
| | | | | | | | | | | | - David Reaich
- The James Cook University Hospital, Middlesbrough, UK
| | | | | | - Jason Moore
- Royal Devon and Exeter University Hospital, Exeter, UK
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10
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Response: An Economic Evaluation of Iron Isomaltoside 1000 Versus Ferric Carboxymaltose in Patients with Inflammatory Bowel Disease and Iron Deficiency Anemia in Denmark. Adv Ther 2019; 36:1821-1825. [PMID: 31154628 PMCID: PMC6822855 DOI: 10.1007/s12325-019-00993-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Indexed: 11/12/2022]
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Pollock RF, Muduma G. A systematic literature review and indirect comparison of iron isomaltoside and ferric carboxymaltose in iron deficiency anemia after failure or intolerance of oral iron treatment. Expert Rev Hematol 2019; 12:129-136. [PMID: 30689458 DOI: 10.1080/17474086.2019.1575202] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The efficacy of oral iron in treating iron deficiency anemia (IDA) can be limited by poor gastrointestinal (GI) absorption and adverse GI symptoms; intravenous (IV) iron is a well-established alternative. The present study compared the efficacy of two IV iron formulations in patients with IDA: iron isomaltoside (IIM) and ferric carboxymaltose (FCM). METHODS A systematic literature review (SLR) was conducted to identify randomized controlled trials (RCTs) of IIM and FCM in patients with IDA. An adjusted indirect treatment comparison (ITC) of IIM and FCM was then conducted to evaluate differences in change from baseline hemoglobin and the proportion of patients achieving a clinically-relevant response. RESULTS The SLR identified no completed RCTs of IIM versus FCM, 5 RCTs of IIM (4 versus oral iron and 1 versus iron sucrose), and 14 RCTs of FCM (11 versus oral iron and 3 versus iron sucrose). In an ITC via iron sucrose, IIM resulted in a significantly larger increase from baseline hemoglobin with a mean difference of +0.249 g/dL with IIM relative to FCM, but there was no significant difference in the proportion of patients with a clinically-relevant response. CONCLUSIONS IIM resulted in a larger increase from baseline hemoglobin than FCM in patients with IDA, but with no difference in the proportion of patients responding. Studies comparing IIM and FCM directly would be needed to confirm these findings.
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Affiliation(s)
| | - Gorden Muduma
- b International Market Access , Pharmacosmos A/S , Holbæk , Denmark
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12
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Pollock RF, Muduma G. An Economic Evaluation of Iron Isomaltoside 1000 Versus Ferric Carboxymaltose in Patients with Inflammatory Bowel Disease and Iron Deficiency Anemia in Denmark. Adv Ther 2018; 35:2128-2137. [PMID: 30456520 DOI: 10.1007/s12325-018-0827-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The incidence of inflammatory bowel disease (IBD) in Denmark is among the highest in the world, with Crohn's disease and ulcerative colitis occurring at rates of 9.1 and 18.6 per 100,000 person-years respectively in 2010-2013. Anemia is the most prevalent extraintestinal complication of IBD, most commonly caused by iron deficiency. In treating IBD-associated iron deficiency anemia (IDA), intravenous iron is more effective and better tolerated and shows a faster response than oral iron. The present study evaluated resource use and costs associated with using iron isomaltoside (Monofer; IIM) versus ferric carboxymaltose (Ferinject; FCM) in patients with IDA and IBD in Denmark. METHODS A budget impact model was developed to evaluate the cost of IIM compared with FCM from a Danish healthcare payer perspective. Iron deficits were modeled using dosing tables and a joint distribution of bodyweight [mean 75.4 kg, standard deviation (SD) 17.4 kg] and hemoglobin (mean 10.8 g/dL, SD 1.4 g/dl) based on observational data from patients with IBD. Retreatment frequency was modeled using a pooled retrospective analysis of randomized trial data, and costs were modeled using diagnosis-related groups with an outpatient infusion cost of DKK 2855. RESULTS Using IIM required 1.2 infusions (per treatment) to correct the mean iron deficit compared with 1.6 with FCM. Treating 2.54 patients with IIM would therefore avoid one infusion compared with FCM. Patients using IIM required multiple infusions in 25.0% of cases compared with 64.3% with FCM. Over 5 years, total estimated costs were DKK 21,406 per patient with IIM compared with DKK 28,137 with FCM, corresponding to savings of DKK 6731 with IIM. CONCLUSION Using IIM in place of FCM markedly reduced the number of iron infusions required in patients with IBD and IDA in Denmark. The reduction in infusions was accompanied by reductions in cost compared with FCM. FUNDING Pharmacosmos A/S.
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