An Economic Evaluation of Iron Isomaltoside 1000 Versus Ferric Carboxymaltose in Patients with Inflammatory Bowel Disease and Iron Deficiency Anemia in Denmark

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 com-monly 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 isomal-toside (Monofer; IIM) versus ferric carboxymal-tose (Ferinject; FCM) in patients with IDA and IBD in Denmark. Methods: A budget impact model was devel-oped to evaluate the cost of IIM compared with FCM from a Danish healthcare payer perspec-tive. 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 diag-nosis-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 mark-edly reduced the number of iron infusions required in patients with IBD and IDA in Den-mark. The reduction in infusions was accom-panied by reductions in cost compared with FCM.