Intravenous iron for the treatment of iron deficiency anemia in China: a patient-level simulation model and cost-utility analysis comparing ferric derisomaltose with iron sucrose

Figures & data

Figure 1. Schematic for a cost-utility model.

Table 1. Baseline population characteristics and disease parameters.

Item	Baseline value	Source
Baseline mean (SD) age, years	39.40 (9.31)	Randomized controlled trial comparing ferric carboxymaltose and iron sucrose for treatment of IDA in China (NCT03591406) and validated in physician survey
Baseline mean (SD) body weight, kg	60.07 (12.0)
Pre-treatment mean (SD) hemoglobin level, g/dL	7.90 (1.48)
Patients with chronic IDA etiology, %	63.95	Analysis of prescription database covering 146 hospitals in nine locations
IV iron received during outpatient procedure, %	15.30
Median time to IDA recurrence, months	10	Kulnigg et al.^32
Median (SD) time to iron retreatment in chronic IDA, months	16.00 (4.34)

Abbreviations: IDA, Iron Deficiency Anemia; SD, Standard Deviation.

Table 2. Unit costs.

Item	Unit cost (RMB)	Source
Intravenous iron administration (per administration)
Service charge	11.66	Median charge for public medical services from Beijing, Guangzhou, Shanghai, Shenzhen, Xiamen
Equipment charge	22.00	Public procurement platform of Hainan Boao Evergrande Hospital
Inpatient costs (only for treatment of iron deficiency anemia, not of underlying diseases if any)
Daily bed and care fee	148.75	Median charge for public medical services from Beijing, Guangzhou, Shanghai, Shenzhen, Xiamen
Outpatient costs
Visit	45.00	Median charge for public medical services from Beijing, Guangzhou, Shanghai, Shenzhen, Xiamen
Laboratory testing
Blood routine	20.00	Median charge for public medical services from Beijing, Guangzhou, Shanghai, Shenzhen, Xiamen
Total iron binding capacity	15.70
Ferritin	23.50
Serum Iron	36.25
Folic acid	50.00
Erythropoietin test	50.00
Vitamin B12	45.00
Treatment costs for adverse events (cardiovascular)
Death due to any cause (end-of-life treatment)	40,000	Physician survey
Myocardial infarction	31,141	National Bureau of Statistics
Stroke	15,331	National Bureau of Statistics
Unstable angina	3,724	Lin and Chen^45
Congestive heart failure	9,198	National Bureau of Statistics
Arrhythmia	3,738	Hu et al.^38
Hypertension	189	Xin^39
Hypotension	41	Wen^44
Treatment costs for adverse events (hypersensitivity reactions)
Narrow terms	455	Gao^40
Respiratory terms	642	Zhang et al.^41
Skin terms	300	Yang and Li^43
Cardiovascular terms	167	Physician survey
Transport costs
Round-trip costs	24.30	Jackson et al.^42
Wages
Hourly wage for patients and caregivers	20.99	Average salary of urban unit personnel employed in 2019 (National Statistical Bureau)

Abbreviations: SD, Standard Deviation.

Table 3. Cost-utility outcomes, in RMB [and USD] per QALY, for different scenarios over a 5-year time horizon.

	FDI	IS	Difference
Life expectancy (years)	4.965	4.965	0
Quality-adjusted life expectancy (QALYs)	3.814	3.736	+0.078
Base scenario: Healthcare system perspective, originator IS unit cost
Total costs (RMB) [USD]	10,380 [2,480]	8,446 [2,018]	+1,934 [+462]
ICUR (RMB [USD] per QALY)	24,901 [5,949]
Alternative scenario: Healthcare system perspective, market-share weighted unit costs of originator and generic IS
Total costs (RMB) [USD]	10,380 [2,480]	6,998 [1,672]	+3,382 [+808]
ICUR (RMB [USD] per QALY)	43,549 [10,403]
Alternative scenario: Societal perspective, originator IS unit cost
Total costs (RMB) [USD]	12,396 [2,961]	14,258 [3,406]	−1,862 [445]
ICUR (RMB per QALY)	FDI dominant

Abbreviations: FDI, Ferric Derisomaltose; ICUR, Incremental Cost-Utility Ratio; IS, Iron Sucrose; QALY, Quality-Adjusted Life-Year; RMB, Renminbi; USD, United States dollar.

Notes: Survival and cost outcomes are all discounted.

Figure 2. Tornado diagram for the base case scenario Abbreviations: CHF; Congestive Heart Failure; FDI, Ferric Derisomaltose; ICUR, Incremental Cost-Utility Ratio; IDA, Iron Deficiency Anemia; IS, Iron Sucrose; QALY, Quality-Adjusted Life-Year; RMB, Renminbi.

Figure 3. Cost-effectiveness acceptability curve for the base scenario Abbreviations: QALY, Quality-Adjusted Life-Year; RMB, Renminbi.

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