A budget impact analysis of iron polymaltose and ferric carboxymaltose infusions

Abstract

Objective: To compare the direct costs of ferric carboxymaltose (FCM) infusions, and iron polymaltose (IPM) infused via either a slow or rapid infusion; and explore potential savings associated with increased uptake of the least-expensive option at a local hospital. Setting: Hospital staff responsible for manufacturing, administering, and monitoring iron infusions, and the patients that received them at the Royal Hobart Hospital in 2018.Method: Frequency analysis identi ed the most prescribed iron infusion doses. A time-motion methodology was used to calculate the direct costs for each protocol at these doses. Finally, a budget-impact analysis of encouraging increased use of the least-expensive infusion protocol was conducted.Main outcome measures: Total direct costs for each infusion protocol at common doses. Potential budget savings associated with switching to the lowest costing of these infusion protocols where possible.Results: The most common doses were 0.5g, 1g, 1.5g and 2g. At these dose points, FCM infusions are the least expensive, but only if national health subsidies are applied. In cases where they do not apply, IPM prepared from ampoules and infused using the rapid protocol ('IPM Ampoules Rapid') is the least expensive. Switching all applicable FCM infusions and IPM infusions administered using the slow infusion protocol to IPM Ampoules Rapid is projected to yield up to $12,000 worth of savings annually.Conclusions: Increased use of the IPM Ampoules Rapid protocol when government-subsidised options are not available is projected to have cost-saving outcomes. Investigation of implementation strategies to increase the use of this protocol are warranted. Impacts On PracticeThis study demonstrates the total direct costs of both the FCM and IPM infused via either a slow or rapid infusion protocol. While there has been a number of studies outlining the safety and e cacy of these infusion protocols, their cost implications have not been fully investigated previously.Amidst the increasing use of intravenous iron, this study outlines which is the overall lowest costing iron infusion protocol, identifying factors contributing to this (e.g. different dose points, health subsidies) and the potential associated costs savings with promoting increased use of lower-costing protocols. Effort should be made to be exible in using the most cost-optimal infusion protocol in different scenarios, whilst also maintaining safety. Interventions to increase the use of lower-costing infusion protocols should be explored.

Management of iron deficiency in women of childbearing age with oral iron intolerance: a prospective, randomised, controlled trial of three doses of an iron-whey-protein formulation

“…Some researchers have advocated for intravenous iron as an efficacious solution to the needs of women with intolerance to oral iron [ 12 ]. However, iron infusions require resource-intensive administration as well as monitoring in an outpatient healthcare setting, and 1 in 10 patients may also experience infusion reactions [ 12 , 13 ]. Adverse GI effects are attributed to iron damage to the intestinal mucosa, in part due to oxidative stress, demonstrated with ferrous sulfate [ 14 – 16 ], and are dose-related [ 3 , 6 , 17 ].…”

Time–motion analysis of external facilitation for implementing the Collaborative Chronic Care Model in general mental health clinics: Use of an interval-based data collection approach

“…Measuring who spends how much time, on what activities and when, can be accomplished through a time–motion study. Time–motion studies conduct such measurement by documenting both the time spent on a work task (e.g., in minutes) and what the task entailed (e.g., the task’s date, purpose, and individuals involved) ( Bradley et al, 2021 ; Lim et al, 2022 ). Time–motion studies are widely used in fields such as industrial engineering to measure the amount of time and movements that employees require to complete work tasks ( Burri Jr. & Helander, 1991 ; Magu et al, 2015 ).…”