Cost-utility analysis of ferric derisomaltose versus ferric carboxymaltose in patients with inflammatory bowel disease and iron deficiency anemia in England

Abstract

Aims

Anemia is the most common extraintestinal complication of inflammatory bowel disease (IBD), with approximately half of cases caused by iron deficiency (ID). Intravenous iron is the preferred ID anemia (IDA) treatment where oral iron is contraindicated, ineffective or not tolerated, or where ID correction is urgent. The objective was to evaluate the cost-utility of ferric derisomaltose (FDI) versus ferric carboxymaltose (FCM) in patients with IBD and IDA in England, in whom IV iron treatment is preferred.

Materials and methods

A patient-level simulation model was developed, capturing quality of life (QoL) differences based on SF-36v2 data from the PHOSPHARE-IBD randomized controlled trial, monitoring and incidence of post-infusion hypophosphatemia, and number of iron infusions required. Analyses were conducted over a five-year time horizon from the Department of Health and Social Care (DHSC) perspective, with healthcare provider and societal perspectives adopted in separate analyses. Future costs and effects were discounted at 3.5% per annum and one-way and probabilistic sensitivity analyses were performed.

Results

FDI increased quality-adjusted life expectancy by 0.075 QALYs versus FCM from 2.57 QALYs to 2.65 QALYs per patient. Patients receiving FDI required 1.63 fewer iron infusions over the five-year time horizon, driving infusion-related cost savings of GBP 496 per patient (GBP 2,188 versus GBP 1,692) from the DHSC perspective. Costs of monitoring and treating hypophosphatemia after FCM were GBP 226, yielding total savings of GBP 722 per patient (GBP 2,414 versus GBP 1,692) over the five-year time horizon. FDI also led to reduced costs versus FCM in the societal and provider analyses and was therefore the dominant intervention across all three perspectives.

Limitations

The analysis did not capture patient adherence, hypophosphatemic osteomalacia, or fractures.

Conclusions

Results showed that FDI improved patient QoL and reduced direct healthcare expenditure versus FCM in patients with IBD and IDA in England.

PLAIN LANGUAGE SUMMARY

Ferric derisomaltose (FDI) is an intravenous iron approved for the treatment of clinically diagnosed iron deficiency in the United Kingdom (UK), and can be an important therapeutic option for patients with inflammatory bowel disease (IBD), who require regular and rapid iron replenishment. Ferric carboxymaltose (FCM) is the sole alternative intravenous iron formulation available in the UK, but is associated with reduced blood phosphate levels, potentially causing fatigue and weakening of the bones. We conducted an economic analysis to weigh the costs and clinical outcomes associated with FDI and FCM in the UK, for patients with IBD and iron deficiency anemia (IDA). The main clinical difference we investigated was reduced blood phosphate levels, which occurred more often after FCM than FDI. We also incorporated recent quality of life data from a clinical study, and calculated the number of infusions (and associated costs) of each iron formulation, that patients would require over five years. Clinical data were obtained from published medical literature, while cost data came from UK sources including the 2022/2023 National Tariff Payment System and the British National Formulary. Our model showed that FDI was associated with quality of life improvements, fewer overall infusions per treatment course, and reduced costs compared to FCM, from the English Department of Health and Social Care perspective, the societal perspective, and the perspective of individual healthcare providers (namely NHS Trusts) within NHS England. FDI is therefore likely to represent the best value intravenous iron for the treatment of IDA with IBD in the UK.

Keywords:

• Cost-utility
• England
• ferric carboxymaltose
• ferric derisomaltose
• inflammatory bowel disease
• iron deficiency anemia

JEL Classification Codes:

• I10
• I1
• I
• I18

Declaration of financial/other relationships

RFP is a full-time employee, director, and shareholder in, and WA is a full-time employee of, Covalence Research Ltd, which received consultancy fees from Pharmacosmos A/S to develop the patient-level simulation model and analysis and prepare the manuscript. TI has attended paid advisory boards for Pharmacosmos A/S and/or its subsidiaries and has received fees for presenting at academic meetings. NK has received speaker honoraria and support for meetings and/or travel from Pharmacosmos A/S, and has participated in an advisory board for Pharmacosmos A/S. AD has received speaker honoraria and support for meetings and/or travel from Pharmacosmos A/S and/or its subsidiaries.

Author contributions

RFP, NK, TI, and AD conceived of and designed the analysis. RFP developed the simulation model and conducted the statistical and health economic analyses with clinical input from NK, TI, and AD. WA conducted sensitivity analyses, generated tables and figures, and prepared the first draft of the manuscript, which was revised critically for intellectual content by all authors. All authors approved the final version to be published. All authors agree to be accountable for all aspects of the work.

Reviewer disclosures

Peer reviewers on this manuscript have received an honorarium from JME for their review work. One of the reviewers has disclosed that they have been involved in research into the safety of these drugs. The other peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Previous presentations

Select analyses presented here were presented previously at ISPOR Europe 2022 (Vienna, November 6 to November 9, 2022) as poster EE395.

Additional information

Funding

Pharmacosmos A/S funded the development of the health economic model and analysis, preparation of the manuscript, and the article processing charge for the manuscript.