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P141. Cost effectiveness of standardised ferric carboxymaltose treatment versus individually calculated iron sucrose treatment for IBD-associated iron deficiency anaemia

F.S. Gutzwiller1, P.R. Blank1, C. Gasche2, R. Evstatiev2, M. Schwenkglenks3,1, T.D. Szucs1

1Institute of Pharmaceutical Medicine/ECPM, University of Basel, Basel, Switzerland; 2Department of Medicine 3, Division of Gastroenterology & Hepatology, Medical University of Vienna, Vienna, Austria; 3Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland

Aim: Iron deficiency and iron deficiency anaemia are common complications of inflammatory bowel disease (IBD) and can be treated with intravenous (i.v.) iron substitution. The FERGIcor trial showed clinical benefits of i.v. iron substitution therapy with ferric carboxymaltose (FCM, Ferinject®, Vifor Pharma) compared to iron sucrose (IS, Venofer®, Vifor Pharma), in anaemic IBD patients. This study evaluated the cost implications and cost-effectiveness of using a simplified FCM-based dosing regimen instead of the Ganzoni-calculated dose regimen of IS for an initial correction phase in anaemic IBD patients, from a third party payer perspective in Switzerland.

Materials and Methods: Data from FERGIcor, an international, multi-centre, randomised, prospective, open-label clinical trial (n = 483) were combined with Swiss public drug prices. Costs of materials used were based on official tariffs. Personnel costs were estimated using the Swiss Tarmed fee-for-service reimbursement system. Cost difference was assessed based on the difference in resource use between the two arms. Administration, material and drug costs were taken into account. Clinical effectiveness was assessed as the response rate difference between treatment groups. Response was defined as a haemoglobin (Hb) increase ≥ 2 g/dL. Time horizon of this within-trial analysis was 12 weeks.

Results and Conclusion: Total iron dose was administered with fewer infusions of FCM (mean ± standard deviation, 2.1±0.6; [mean, 1377 mg iron]) than IS (5.8±1.6; [1160 mg iron]). Costs per single dose and study period are shown in Table 1. Total treatment costs over the study period were €491 for FCM and €802 for IS.

Treatment with FCM was dominant with savings of €311 per patient and 12% more responders than in the IS arm. Initial sensitivity analysis confirmed these results to be robust. The highest single cost factor in this analysis was “administration costs for IS” that outweighed the higher “drug costs for FCM”. From the Swiss payers' perspective, managing anaemia in IBD patients using a simplified FCM-based dosing regimen compared with a Ganzoni-calculated dose regimen of IS, appears to be cost-effective and cost saving. Such analysis may vary according to geographical differences in drug costs as well as costs for human resources. For a more complete health economic assessment, the findings of FERGImain, a subsequent maintenance study, will need to be taken into account.

Table 1. Costs per single dose and over study period (rounded values)
 Cost
 FCMIS
Drug, per single dose€170€42
Material, per single dose€6€6
Administration, per single dose€58€90
Total treatment, per single dose€234€138
Total treatment, over study period€491€802