A patient-level cost-effectiveness analysis of iron isomaltoside versus ferric carboxymaltose for the treatment of iron deficiency anemia in the United Kingdom

Figures & data

Figure 1. Model schematic.

Table 1. Characteristics of studies included in the indirect treatment comparison.

Trial	Population	N*	Baseline Hb (g/dL)^†	Baseline bodyweight (kg)^†	Intervention	Comparator	Outcome (primary endpoint)
Derman et al. 2017	IDA Multiple causes	511	9.2 ± 1.4	86 ± 23	IIM Simplified dosing scheme	IS Ganzoni	Proportion of patients with hemoglobin increase ≥2 g/dL from baseline to any time between weeks 1 to 5.
Evstatiev et al. 2011	IDA IBD	485	10.1 ± 1.5	NR	FCM Simplified dosing scheme	IS Ganzoni	Proportion of patients with hemoglobin increase ≥2 g/dL from baseline to week 12.
Onken et al. 2014	IDA NDD-CKD	2,584	10.31 ± 0.83	89.65 ± 24.75	FCM 1500 mg (750 mg × 2)	IS 1000 mg (200 mg × 5)	Highest change in hemoglobin from baseline to day 56.
Mahey et al. 2016	IDA HUB (IUB)	60	7.42 ± 1.23	56.4 ± 12.0	FCM Ganzoni	IS Ganzoni	Change in hemoglobin from baseline to week 12.

Abbreviations. FCM, ferric carboxymaltose; HUB, heavy uterine bleeding; IBD, inflammatory bowel disease; IDA, iron deficiency anemia; IIM, iron isomaltoside/ferric deriosmaltose; IS, iron sucrose; NDD-CKD, non-dialysis dependent chronic kidney disease; NR, not reported.

*Total randomized, ^†Mean ± standard deviation in intervention arm.

Table 2. Overview of iron deficiency anemia treatment activity and tariffs by healthcare resource group.

HRG code	HRG name	NHS Activity 2017-18	Combined day case / ordinary elective spell tariff 2019-20 (GBP)
SA04G	Iron Deficiency Anaemia with CC Score 14+	3,523	1,062
SA04H	Iron Deficiency Anaemia with CC Score 10-13	6,120	408
SA04J	Iron Deficiency Anaemia with CC Score 6-9	13,327	335
SA04K	Iron Deficiency Anaemia with CC Score 2-5	25,760	289
SA04L	Iron Deficiency Anaemia with CC Score 0-1	26,693	257
Average tariff weighted by 2017-18 activity (GBP)		331.56

Abbreviations. CC, complication; GBP, 2019 pounds sterling.

Figure 2. Scatterplot, least squares regression, and contour plot of the relationship between baseline hemoglobin and change from baseline hemoglobin in patients in the PROVIDE randomized controlled trial²⁰.

Figure 3. Scatterplot and least squares regression models of baseline hemoglobin and change from baseline hemoglobin distributions for iron isomaltoside and ferric carboxymaltose in simulated patient cohorts of 100,000 patients in each arm.

Table 3. Hematological, posological, and economic results from the base case analysis of 100,000 simulated patients.

	FCM	IIM	Difference
Baseline hemoglobin (g/dL)	10.04	10.04	0.00
Change from baseline hemoglobin (g/dL)	2.49	2.74	+0.25
Proportion responding (%)	69.98	79.05	+9.07
Hemoglobin after treatment (g/dL)	12.53	12.78	+0.25
Iron infusions required per patient	1.92	1.38	−0.54
Total cost of infusions (GBP)	637.13	458.04	−179.09
Cost per responder (GBP)	910.45	579.45	−331.00
NNT to avoid one infusion	1.85
Incremental cost per responder (GBP)	IIM dominant (cost saving and more effective)

Abbreviations. FCM, ferric carboxymaltose; IIM, iron isomaltoside/ferric derisomaltose; NNT, number needed to treat.

Figure 4. Kernel density plots showing sampled beta distributions of (A) baseline hemoglobin and (B) change from baseline hemoglobin parameterized using patient-level data from the iron isomaltoside arm of the PROVIDE randomized controlled trial and the difference in change from baseline hemoglobin from an indirect treatment comparison. (C) The final modeled hemoglobin distributions^15,21. Abbreviations. FCM, ferric carboxymaltose; IIM, iron isomaltoside/ferric deriosmaltose; IV, intravenous.

Table 4. One-way sensitivity analysis results.

	Proportion responding (%)			Total cost (GBP)			ICER (GBP/responder)
Analysis	FCM	IIM	Difference	FCM	IIM	Difference
Base case	69.98	79.05	+9.07	637.13	458.04	−179.09	IIM dominant
Distributional assumptions from NIMO	69.28	78.16	+8.88	657.28	468.04	−189.24	IIM dominant
Ganzoni equation	69.98	79.05	+9.07	512.56	380.79	−131.76	IIM dominant
Infusion cost based on HRG SA04L (GBP 257)	69.98	79.05	+9.07	493.84	355.03	−138.81	IIM dominant
Infusion cost based on HRG SA04G (GBP 1,062)	69.98	79.05	+9.07	2040.72	1467.09	−573.62	IIM dominant
Random seed change	69.88	78.67	+8.79	637.06	458.71	−178.35	IIM dominant

Abbreviations. FCM, ferric carboxymaltose; GBP, 2019 pounds sterling; HRG, healthcare resource group; ICER, incremental cost-effectiveness ratio; IIM, iron isomaltoside.; NIMO, Non-interventional Monofer Study.

Derman R, Roman E, Modiano MR, et al. A randomized trial of iron isomaltoside versus iron sucrose in patients with iron deficiency anemia. Am J Hematol. 2017;92(3):286–291.

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