Evaluation of the Cost-Effectiveness of Iron Formulations for the Treatment of Iron Deficiency Anaemia in Patients with Inflammatory Bowel Disease in the UK

Figures & data

Table 1 Treatment Efficacy: Odds Ratio for Response Rate

	Odds Ratio Compared with Ferric Carboxymaltose	Lower 95% Credible Interval	Upper 95% Credible Interval
Ferric derisomaltose	0.69	0.34	1.40
Iron sucrose	0.70	0.48	1.00
Oral iron	0.53	0.32	0.89

Notes: Response was defined as a patient who achieved normalisation of haemoglobin levels or an increase in haemoglobin of ≥2 g/dL.

Table 2 Simplified Dosing Table

Haemoglobin (g/dL)	Body Weight (kg)
	<35	35–70	≥70
<10	500	1,500	2,000
10–14	500	1,000	1,500
≥14	500	500	500

Note: Response was defined as a patient who achieved normalisation of haemoglobin levels or an increase in haemoglobin of ≥2 g/dL.

Table 3 Resource Use Associated with Infusion of IV Iron Formulations

	Ferric Carboxymaltose	Ferric Derisomaltose	Iron Sucrose
Infusion time
<500 mg	6	–	–
500–1000 mg	15	–	–
<1000 mg	–	15	–
>1000 mg	–	30	–
<50 mg	–	–	8
50–100 mg	–	–	15
100–200 mg	–	–	30
Preparation time (minutes)	15	15	15
Observation time (minutes)	30	30	30
Giving sets required	1	1	1
Cannula required	1	1	1
Dressings required	1	1	1

Table 4 Pack Contents and Pack Costs of IV Iron Formulations

	Pack Contents	Pack Cost (GBP)	Cost per mg Iron (GBP)
Ferric carboxymaltose	5 vials each containing 100 mg iron	95.50	0.19
Ferric carboxymaltose	5 vials each containing 500 mg iron	477.50	0.19
Ferric carboxymaltose	1 vial containing 1,000 mg iron	154.23	0.15
Ferric derisomaltose	2 vials containing 1000 mg iron	339.00	0.17
Ferric derisomaltose	5 vials each containing 100 mg iron	84.75	0.17
Ferric derisomaltose	5 vials each containing 500 mg iron	423.75	0.17
Iron sucrose	5 vials each containing 100 mg iron	51.24	0.10

Note: GBP, 2020 pounds sterling. Costs extracted from the British National Formulary.²⁷

Figure 1 Number needed to treat to bring achieve one additional responder with ferric carboxymaltose versus other therapy options. Number needed to treat was expressed as the number of patients who would need to be treated to with ferric carboxymaltose instead of the comparator in order achieve one additional responder. Number needed to treat values are conventionally rounded up to the next integer value. Only the difference between the efficacy of FCM and oral iron was based on a statistically significant difference in the model input.

Table 5 Results of the Base Case Modelling Analysis

	Ferric Carboxymaltose	Ferric Derisomaltose	Iron Sucrose	Oral Iron
Responders (%)	81 (2)	74 (6)	75 (4)	69 (4)
Iron dose (mg)	1,441 (431)	1,441 (426)	1,441 (426)	–
Number of infusions	1.7 (0.5)	1.6 (0.5)	7.5 (1.1)	–
Cost of treatment	296 (81)	312 (88)	503 (147)	56 (0)
Additional cost per additional responder with ferric carboxymaltose versus the comparator		Ferric carboxymaltose more effective and less costly	Ferric carboxymaltose more effective and less costly	GBP 2045 per additional responder
Additional cost per additional responder with ferric derisomaltose versus the comparator	Ferric derisomaltose less effective and more costly		Ferric derisomaltose less effective and less costly	GBP 5146 per additional responder
Additional cost per additional responder with iron sucrose versus the comparator	Iron sucrose less effective and more costly	GBP 29,161 per additional responder		GBP 7940 per additional responder

Notes: GBP, 2020 pounds sterling. Response was defined as a patient who achieved normalisation of haemoglobin levels or an increase in haemoglobin of ≥2 g/dL. Values are mean (standard deviation).

Figure 2 Scatterplot of the base case results. GBP, 2020 pounds sterling. Response was defined as a patient who achieved normalisation of haemoglobin levels or an increase in haemoglobin of ≥2 g/dL.

Table 6 Scenario Analysis Results

	Additional Cost per Additional Responder with Ferric Carboxymaltose versus the Comparator
	Ferric Carboxymaltose versus Ferric Derisomaltose	Ferric Carboxymaltose versus Iron Sucrose	Ferric Carboxymaltose versus Oral Iron
Base case analysis (simplified dosing table used in all arms)	Ferric carboxymaltose more effective and less costly	Ferric carboxymaltose more effective and less costly	GBP 2,045 per additional responder
Ganzoni formula used in all arms	Ferric carboxymaltose more effective and less costly	Ferric carboxymaltose more effective and less costly	GBP 2,019 per additional responder
Simplified dosing table used in ferric carboxymaltose arm, Ganzoni formula used in the ferric derisomaltose and iron sucrose arms	Ferric carboxymaltose more effective and less costly	Ferric carboxymaltose more effective and less costly	GBP 2,045 per additional responder

Notes: GBP, 2020 pounds sterling. Response was defined as a patient who achieved normalisation of haemoglobin levels or an increase in haemoglobin of ≥2 g/dL.

Table 7 Sensitivity Analysis Results

	Additional Cost per Additional Responder with Ferric Carboxymaltose versus the Comparator
	Ferric Carboxymaltose versus Ferric Derisomaltose	Ferric Carboxymaltose versus Iron Sucrose	Ferric Carboxymaltose versus Oral Iron
Base case analysis	Ferric carboxymaltose more effective and less costly	Ferric carboxymaltose more effective and less costly	GBP 2045 per additional responder
Upper 95% CI of odds ratios	Ferric carboxymaltose less effective and less costly	Ferric carboxymaltose more effective and less costly	GBP 12751 per additional responder
Lower 95% CI of odds ratios	Ferric carboxymaltose more effective and less costly	Ferric carboxymaltose more effective and less costly	GBP 1035 per additional responder
Body weight increased by 10 kg	Ferric carboxymaltose more effective and less costly	Ferric carboxymaltose more effective and less costly	GBP 2258 per additional responder
Haemoglobin increased by 1 g/dL	Ferric carboxymaltose more effective and less costly	Ferric carboxymaltose more effective and less costly	GBP 1866 per additional responder
Haemoglobin decreased by 1 g/dL	Ferric carboxymaltose more effective and less costly	Ferric carboxymaltose more effective and less costly	GBP 2190 per additional responder

Notes: GBP, 2020 pounds sterling. Response was defined as a patient who achieved normalisation of haemoglobin levels or an increase in haemoglobin of ≥2 g/dL.

National Institute for Health and Care Excellence. British National Formulary. Available from: www.nice.org.uk/bnf. Accessed March 13, 2020.

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