Economic evaluation of intravenous iron treatments in the management of anemia patients in Greece

Figures & data

Table 1 Costing methodology used in the model

Parameter	Direct cost computation
Total cost of drugs	Number of units × cost per unit
Total cost of disposables	(Units of disposable per infusion × unit cost) × number of visits
Total monitoring cost True hospital cost	(Gross salary of doctor per month/25 days/480 minutes/day + gross salary of nurse per month/25 days/480 minutes/day) × minutes of infusion × number of infusions (Total infusion hours/8 hours) × hospital cost × number of visits
	Indirect cost computation
Total productivity loss	Number of visits × (Gross domestic product per capita/300)
Total traveling cost	Number of visits × traveling cost per visit

Notes: Disposable: cannula and serum device. In the case of inpatients, as “number of visits”, we have used the number of additional visits for infusion after patient discharge.

Table 2 Cost per item used in the model

Cost of drugs*	Cost (€) per unit	Total number of units
		Inpatients	Outpatients
Cosmofer (5 amp × 100 mg)	28.48	2	2
Venofer (5 amp × 100 mg)	31.64	2	2
Ferinject (5 amp × 100 mg)	85.93	2	2
Cost for personnel time	Cost (€) per hour**	Needed hours	Needed hours
Doctor/nurse	€11.50/€6.50
Cosmofer		8	8
Venofer		10	10
Ferinject		0.25	0.25
Number of additional visits	Cost (€) per visit**
Cosmofer	280.00	0	1
Venofer	280.00	2	5
Ferinject	280.00	0	1
Disposables per visit	Cost (€) per unit	Units per infusion	Units per infusion
Serum device	0.36	1	1
Cannula	0.40	1	1

Notes:

* Price Bulletin;

** National School of Public Health.

Table 3 Total cost and cost components per treatment arm

Mean (95% LUI–95% UUI)	FCM	IS	LMWID
Outpatient
Direct cost (€)
Drugs	171.9 (n/a)	63.3 (n/a)	57 (n/a)
Adverse events	12.4 (8.4–18)	12.4 (8.4–18)	12.4 (8.4–18)
Disposables	0.8 (0.5–1.1)	3.8 (3.5–4.1)	0.8 (0.5–1.1)
Monitoring	4.8 (3.8–6)	197.7 (176–219.6)	159.9 (125.1–196)
Hospital cost	8.8 (7.9–9.8)	350.5 (315.1–392.6)	280.4 (252.1–314.1)
Total direct cost	198.6 (194.3–204.2)	627.7 (587.9–675.8)	510.5 (465.4–560.5)
Other costs (€)
Productivity loss	73.3 (39.7–128.2)	366.7 (212.5–580.2)	96 (65.2–138.7)
Traveling cost	40.4 (33.9–48.1)	202 (169.6–240.7)	40.4 (33.9–48.1)
Total other costs	113.7 (73.6–176.3)	568.7 (382–820.9)	136.4 (99.1–186.9)
Inpatient
Direct cost (€)
Drugs	171.9 (n/a)	63.3 (n/a)	57 (n/a)
Adverse events	12.5 (8.7–17.7)	12.5 (8.7–17.7)	12.5 (8.7–17.7)
Disposables	0 (n/a)	1.5 (1.2–1.8)	0 (n/a)
Monitoring	4.8 (3.8–5.9)	197.5 (177.3–220.4)	159.3 (126–195.6)
Hospital cost	0 (n/a)	140 (125.9–156.1)	0 (n/a)
Total direct cost	189.2 (185.1–194.4)	414.9 (388.7–442.7)	228.8 (194.1–265.2)
Other costs (€)
Productivity loss	0 (n/a)	144.5 (86.3–225.7)	22.7 (17.7–28)
Traveling cost	0 (n/a)	80.1 (66.6–95.6)	0 (n/a)
Total other costs	0 (n/a)	224.7 (152.9–321.3)	22.7 (17.7–28)

Notes: Based on 1000 bootstrap replications.

Abbreviations: LUI, lower uncertainty interval; UUI, upper uncertainty interval; FCM, ferric carboxymaltose; IS, iron sucrose; LMWID, low-molecular-weight iron dextran.

Figure 1 Budget impact analysis per year for a cohort of 100 patients.*

Note: *Assuming 100% substitution rate amongst comparators.
Abbreviations: FCM, ferric carboxymaltose; IS, iron sucrose; LMWID, low-molecular-weight iron dextran.

Table 4 Total cost per treatment arm* based on one-way sensitivity analysis for the main model parameters

	−20%	20%	(−20%)			(+20%)
			FMC	IS	LMWID	FMC	IS	LMWID
Inpatients
Cost per drug unit for FMC	68.7	103.1	€154.0	€401.3	€217.0	€222.7	€401.3	€217.5
Gross salary per month (Doctor)	1,840.0	2,760.0	€187.8	€377.7	€198.5	€188.9	€424.9	€236.4
Gross salary per month (Nurse)	1,040.0	1,560.0	€188.0	€388.0	€206.8	€188.7	€414.6	€228.2
Additional visits (for IS)	1	3	€188.4	€330.5	€217.5	€188.4	€472.0	€217.5
Cost per visit	224.0	336.0	€188.4	€401.3	€217.5	€188.4	€401.3	€217.5
Outpatients
Cost per drug unit for FMC	68.7	103.1	€163.5	€613.6	€498.2	€232.3	€613.6	€498.2
Gross salary per month (Doctor)	1,840	2,760	€197.3	€519.3	€479.3	€198.5	€566.4	€517.2
Gross salary per month (Nurse)	1,040	1,560	€197.5	€529.5	€487.5	€198.2	€556.2	€509.0
Additional visits (for IS)	4	6	€197.9	€542.8	€498.2	€197.9	€684.3	€498.2
Cost per visit	224.0	336.0	€196.1	€613.6	€442.2	€199.6	€613.6	€554.2

Note:

* Only direct cost was considered.

Abbreviations: FCM, ferric carboxymaltose; IS, iron sucrose; LMWID, low-molecular-weight iron dextran.