Cost effectiveness of implementing ESC guidelines for treatment of iron deficiency in heart failure in the Nordic countries

Figures & data

Table 1. Unit costs of resources (2017 price levels in euros and local currencies), [18, 19, 21–23].

	Denmark		Finland	Norway		Sweden
	DKK	EUR	EUR	NOK	EUR	SEK	EUR
Hospitalization for HF	30413.00	4088.54	2951.91	48567.41	5207.18	41291.00	4285.48
Visit at cardiology department	1137.00	152.85	290.04	1795.63	192.52	1008.00	104.62
FCM, cost per 100 mg	118.80	15.97	14.26	128.00	13.72	146.50	15.20
Visit for diagnostic tests	328.09	44.11	40.40	453.66	48.64	412.00	42.76
Laboratory tests	50.17	6.74	6.18	69.37	7.44	63.00	6.54

DKK: Danish kroner, EUR: euros, NOK: Norwegian kroner, SEK: Swedish kronor.

Unit costs of FCM refer to mean prices in each country during 2017.

The unit costs for visit for diagnostic tests and laboratory tests are based on Swedish unit costs and are adjusted for purchasing power parity differences between countries [17, 20]. Laboratory tests includes tests for serum ferritin (SEK 30), serum iron (SEK 10), total iron-binding capacity (SEK 13), transferrin saturation (SEK 0), and hemoglobin in blood (SEK 10).

Table 2. Parameter values for the base case scenario and the sensitivity analysis.

Parameter	Base case value	Value in sensitivity analysis
EQ-5D-based QALY per patient, difference FCM–Placebo	0.050	0.003–0.098
Allocation of patients (based on Hb and weight) and FCM dosing scheme, [15]
- <100 g/L, <70 kg: 1 × 1000 mg +1 × 500 mg	1.3%	0%
- <100 g/L, ≥70 kg: 2 × 1000 mg	2.0%	100%
- ≥100 & <140 g/L, <70 kg: 1 × 1000 mg	21.1%	0%
- ≥100 & <140 g/L, ≥70 kg: 1 × 1000 mg +1 × 500 mg	62.5%	0%
- ≥140 & <150 g/L, <70 kg: 1 × 500 mg	2.0%	0%
- ≥140 & <150 g/L, ≥70 kg: 1 × 500 mg	11.2%	0%
Patient share requiring one additional treatment, [15]	18.9%	100%
- of which receive 1 × 500 mg	25%	0%
- of which receive 1 × 1000 mg	25%	0%
- of which receive 1 × 1000 mg +1 × 500 mg	50%	100%
Treatment setting
Visit costs for initial diagnostics	Excluded	Included
Visit costs for initial FCM administration	Only 2nd visit	Included
Visit costs for additional FCM administration	Only 2nd visit	Included
Visit costs for follow-up diagnostics	Excluded	Included
Hospitalization rate per patient, difference FCM–Placebo^a [15]	−0.164	No difference

EQ-5D: EuroQoL five dimensions; QALY: quality-adjusted life year; FCM: ferric carboxymaltose; Hb: hemoglobin level.

a Based on the parameter “hospitalization for any cardiovascular cause”.

Figure 1. Mean costs per patient (in 2017 €) in the treatment group (FCM) and the placebo group (no treatment) in the base case scenario.

FCM: ferric carboxymaltose; €: euros.

Table 3. Results of the cost-utility analysis and the sensitivity analysis (in 2017 €).

	Costs			QALY	ICER
Country/Scenario	FCM	No treatment	Difference^a	Difference^a
Denmark
Base case	1082	1381	−298	0.050	Dominant
All visit costs for administration included	1264	1381	−117	0.050	Dominant
Visit costs for diagnostics included	1202	1381	−179	0.050	Dominant
All visit costs included/excluded	1383/967	1381	2/−413	0.050	47/dom.
No difference in hospitalizations	1755	1381	374	0.050	7485
Finland
Base case	961	997	−36	0.050	Dominant
All visit costs for administration included	1306	997	309	0.050	6192
Visit costs for diagnostics included	1070	997	73	0.050	1472
All visit costs included/excluded	1415/743	997	418/−254	0.050	8377/dom.
No difference in hospitalizations	1447	997	450	0.050	9007
Norway
Base case	1275	1759	−484	0.050	Dominant
All visit costs for administration included	1504	1759	−255	0.050	Dominant
Visit costs for diagnostics included	1406	1759	−352	0.050	Dominant
All visit costs included/excluded	1635/1130	1759	−123/−629	0.050	Dominant
No difference in hospitalizations	2131	1759	372	0.050	7458
Sweden
Base case	1068	1447	−379	0.050	Dominant
All visit costs for administration included	1193	1447	−255	0.050	Dominant
Visit costs for diagnostics included	1184	1447	−264	0.050	Dominant
All visit costs included/excluded	1308/990	1447	−139/−458	0.050	Dominant
No difference in hospitalizations	1773	1447	325	0.050	6517

€: euros; QALY: quality-adjusted life year; ICER: incremental cost-effectiveness ratio; FCM: ferric carboxymaltose.

a A positive cost (QALY) difference indicates that FCM is more expensive (effective) than no treatment.

Table 4. Characteristics of the CONFIRM-HF study population at baseline and of patients in national HF registries.

Characteristic	CONFIRM-HF [15]	Danish Heart Failure Registry [30]	Norwegian Heart Failure Registry [31]	Swedish Heart Failure Registry [32]
Patient population	Iron-deficient HF patients	Primary diagnosis of HF	Primary or secondary diagnosis of HF	Primary or secondary diagnosis of HF
Year	∼2012	2013–2014	2016	2003–2015
Number of patients	301	3,631	1,835	63,453
Age, years	69	70	69	75
Females, %	47	31	29	39
BMI, kg/m²	29	N/A	N/A	27
NYHA class	II 57% III 43%	N/A	2.3	I 12%, II 44%, III 38%, IV 6%
Hemoglobin, g/L	124	N/A	N/A	130
Serum ferritin, µg/L	57	N/A	N/A	N/A
Transferrin saturation, %	19	N/A	N/A	N/A
Concomitant disease
Atrial fibrillation	46%	26%	N/A	∼51%
Diabetes mellitus	28%	20%	N/A	∼25%
Hypertension	86%	45%	N/A	∼50%
Previous myocardial infarction	60%	36%	N/A	∼36%
Previous stroke	15%	10%	10%	∼12%
Concomitant treatment
Beta blockers	90%	N/A	94%^a	∼90%^b
Diuretics	90%	N/A	N/A	∼78%^b
ACE inhibitors and/or ARBs	77%/24%	N/A	93%^a	∼87%^b

Data refer to mean value or share of patients affected.

HF: heart failure; BMI: body mass index; NYHA: New York Heart Association; N/A: not available; ACE: angiotensin-converting-enzyme; ARBs: angiotensin II receptor blockers.

a Refers only to HF patients with reduced ejection fraction examined at their latest outpatient visit.

b Refers only to HF patients with reduced ejection fraction diagnosed in 2008–2015.

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