Budget impact of intravenous iron therapy with ferric carboxymaltose in patients with chronic heart failure and iron deficiency in Germany

Abstract

AimsTreatment of iron deficiency (ID) in patients with heart failure (HF) with intravenous iron substitution [ferric carboxymaltose (FCM)] has previously shown significant improvements in exercise capacity, New York Heart Association (NYHA) functional class, quality of life, and reduction of hospitalization. The aim of this study was to estimate the budget impact of FCM treatment for patients with HF and ID.Methods and resultsIndividual patient data from four double‐blind randomized controlled trials were pooled for this analysis. Expected outcomes were modelled for a treatment period of 1 year, using multivariate statistical methods. Associated unit costs were derived from claims data. Budget impact was calculated from the perspective of the Statutory Health Insurance. Multiple deterministic sensitivity analyses were performed. The annual budget impact for therapy with FCM vs. no‐iron therapy was €2 735 505 and €2 695 474 for 1000 patients, respectively, resulting in additional annual costs of €40.03 for each treated patient. Main costs drivers are the FCM treatment cost and cost of hospitalizations due to HF worsening. FCM therapy compared with no‐iron therapy resulted in reduced cost per 1000 patients: for reduced hospitalization due to HF worsening (52 vs. 129 hospitalizations amounting to €230 591 vs. €597 078), for reduced other medication (€1 611 007 vs. €1 679 908), fewer outpatient visits (€332 523 vs. €378 019), and home visits (€29 627 vs. €40 469). Sensitivity analyses showed robustness of the results.ConclusionsTherapy with FCM has a minimal budget impact of €40 031 per 1000 patients per year. This budget impact translates into reduced and shorter hospitalizations and improved symptomatic status of the patients.

Budget impact of intravenous ferric carboxymaltose in patients with chronic heart failure and iron deficiency in France

“…In the base case analysis, FCM use is predicted to be cost saving over 5 years of treatment (€À0.8m). The German budget impact analysis, 19 based on the same pooled RCT data, compared treatment with FCM for all patients vs. no iron treatment, using 1000 patients in each group, from the perspective of the German national health insurance over a 1 year period. It concluded that in the first year, FCM was cost saving (€À198 768) if the dose of FCM was 925 mg and had a limited positive impact if the dose of 1679 mg was used (€40 031).…”

“…To estimate the budget impact of FCM treatment, we adapted a decision analytic model previously used to assess the budget impact of FCM in Germany, 19 to the French setting. The adaptation was made to meet the French guidelines on budget impact analysis from the national health authorities (Haute Autorité de Santé).…”

“…In another secondary analysis, hospitalization costs are differentiated by NHYA class, using the same variation between classes as those used in the initial budget impact model, 19 in the absence of French sources reporting hospitalization costs by NHYA classes. In the first secondary analysis, the cost of two ambulatory administrations was considered for FCM treatment.…”

“…A log-negative binomial regression analysis from the initial model 19 was used to estimate the hospitalization rate due to CHF worsening. A log-link negative binomial regression was used to estimate the mean length of stay per hospitalization due to CHF worsening.…”

“…In the base case analysis, hospitalization costs are not differentiated by NYHA class. In another secondary analysis, hospitalization costs are differentiated by NHYA class, using the same variation between classes as those used in the initial budget impact model, 19 in the absence of French sources reporting hospitalization costs by NHYA classes. In another secondary analysis, we considered a length of hospital stay extracted from the national PMSI database (mean length of stay).…”