Managing iron deficiency and iron deficiency anemia in inflammatory bowel disease. The results of the "Gestiona hierro-EII" survey

Cost-effectiveness analysis of ferric carboxymaltose versus iron sucrose for the treatment of iron deficiency anemia in patients with inflammatory bowel disease in Spain

BACKGROUND

Iron deficiency anemia (IDA) is a common complication of inflammatory bowel disease (IBD) and can result in reduced quality of life and increased healthcare costs. IDA is treated with iron supplementation, commonly with intravenous iron formulations, such as ferric carboxymaltose (FCM), and iron sucrose (IS).

METHODS

This study assessed the cost-effectiveness of FCM compared with IS, in terms of additional cost per additional responder in patients with IDA subsequent to IBD in the Spanish setting. An economic model was developed to assess the additional cost per additional responder, defined as normalization or an increase of ⩾2 g/dl in hemoglobin levels, for FCM versus IS from a Spanish healthcare payer perspective. Efficacy inputs were taken from a randomized controlled trial comparing the two interventions (FERGIcor). Costs of treatment were calculated in 2021 Euros (EUR) using a microcosting approach and included the costs of intravenous iron, healthcare professional time, and consumables. Cost-effectiveness was assessed over one cycle of treatment, with a series of sensitivity analyses performed to test the robustness of the results.

RESULTS

FCM was more effective than IS, with 84% of patients achieving a response compared with 76%. When expressed as number needed to treat, 13 patients would need to switch treatment from IS to FCM in order to achieve one additional responder. Costs of treatment were EUR 323 with FCM compared with EUR 470 with IS, a cost saving of EUR 147 with FCM. Cost savings with FCM were driven by the reduced number of infusions required, resulting in a reduced requirement for healthcare professional time and use of consumables compared with the IS arm.

CONCLUSION

The present analysis suggests that FCM is less costly and more effective than IS for the treatment of IDA subsequent to IBD in Spain and therefore was considered dominant.

Management of anaemia in patients with inflammatory bowel disease - results of a questionnaire among Polish healthcare professionals

Introduction

Anaemia is the most common systemic and extraintestinal complication of inflammatory bowel disease (IBD). Its impact on quality of life is significant; hence, it is important for healthcare professionals to manage it correctly.

Aim

To assess the knowledge among doctors about the diagnostics and treatment of anaemia in IBD patients.

Material and methods

The questionnaire survey was conducted among 169 doctors of different specialties. Eighty-seven (51.5%) of the respondents were gastroenterologists.

Results

97.7% (84) of gastroenterologists and 92.6% (75) of all responders replied that all IBD patients should be monitored for anaemia (p = 0.266); however, only one-third of gastroenterologists knew the exact haemoglobin cut-off level in men with Crohn's disease. The necessity of monitoring vitamin B₁₂ was indicated by 53.7% (36) of gastroenterologists and by 24.1 % (13) of other specialists (p = 0.002). Nine percent (6) of gastrologists and 3.7% (2) of other specialists screened for folic acid (p = 0.0431). 13.1% (11) of gastroenterologists and 35% (28) of other specialists frequently used iv iron (p = 0.003). 44.1% (26) of gastroenterologists and 52% (26) of other specialists administered between 1000 mg and 1500 mg of iv iron during hospitalization. Only 11.9 % (7) of GI-specialists and 2% (1) of non-GI-specialists administered total doses over 1500 mg (p = 0.155). 71% (62) of gastroenterologists and 73% (60) of all physicians did not observe any adverse events of iv iron.

Conclusions

Although the diagnostic approach to anaemia in IBD patients varies among respondents, knowledge of guidelines was slightly better among GI-professionals then among other doctors.

Management of haemostatic alterations and associated disorders in cirrhosis in Spain: A national survey

BACKGROUND

Knowledge of haematological abnormalities in cirrhosis has greatly improved in recent years.

AIMS

To evaluate how Spanish Digestive Disease specialists manage haemostatic alterations and associated disorders in patients with cirrhosis.

METHODS

All members of the Spanish Association for the Study of the Liver and Spanish Society of Digestive Pathology were invited to fill in a web-based questionnaire.

RESULTS

135 professionals, 93 hepatologists and 42 non-hepatologists responded to the survey. The concept of rebalanced haemostasis was known by 74.8% of them. Most specialists corrected the INR and thrombocytopenia before invasive procedures with moderate risk of bleeding or major surgery and in severe gastrointestinal bleeding. The threshold of platelets and, especially, INR used to administer blood products varied greatly. Pharmacological prophylaxis of venous thromboembolism prevailed, but it was highly dependent on the INR and platelet figures. Most participants initiated anticoagulation regardless of the degree of portal vein thrombosis, even in patients ineligible for transplantation. In potential candidates, only 56% maintained it indefinitely or until liver transplantation. No major differences between hepatologists and non-hepatologists were found.

CONCLUSIONS

A significant variability and certain deviation from current guidelines was observed among Spanish Digestive Disease specialists regarding management of haemostatic alterations and associated disorders in cirrhosis.

Stress Triggers Flare of Inflammatory Bowel Disease in Children and Adults

Inflammatory bowel disease (IBD) is an idiopathic inflammatory disease characterized by chronic and relapsing manifestations. It is noteworthy that the prevalence of IBD is gradually increasing in both children and adults. Currently, the pathogenesis of IBD remains to be completely elucidated. IBD is believed to occur through interactions among genetics, environmental factors, and the gut microbiota. However, the relapsing and remitting course of IBD underlines the importance of other modifiers, such as psychological stress. Growing evidence from clinical and experimental studies suggests that stress acts as a promoting or relapsing factor for IBD. Importantly, recent studies have reported an increasing incidence of anxiety or depression in both children and adults with IBD. In this article, we review the mechanisms by which stress affects IBD, such as via impaired intestinal barrier function, disturbance of the gut microbiota, intestinal dysmotility, and immune and neuroendocrine dysfunction. With regard to both children and adults, we provide recent evidence to describe how stress can affect IBD at various stages. Furthermore, we emphasize the importance of mental healing and discuss the value of approaches targeting stress in clinical management to develop enhanced strategies for the prevention and treatment of IBD.