Skip to main content

An Economic Evaluation of Iron Isomaltoside 1000 Versus Ferric Carboxymaltose in Patients with Inflammatory Bowel Disease and Iron Deficiency Anemia in Denmark



The incidence of inflammatory bowel disease (IBD) in Denmark is among the highest in the world, with Crohn’s disease and ulcerative colitis occurring at rates of 9.1 and 18.6 per 100,000 person-years respectively in 2010–2013. Anemia is the most prevalent extraintestinal complication of IBD, most commonly caused by iron deficiency. In treating IBD-associated iron deficiency anemia (IDA), intravenous iron is more effective and better tolerated and shows a faster response than oral iron. The present study evaluated resource use and costs associated with using iron isomaltoside (Monofer; IIM) versus ferric carboxymaltose (Ferinject; FCM) in patients with IDA and IBD in Denmark.


A budget impact model was developed to evaluate the cost of IIM compared with FCM from a Danish healthcare payer perspective. Iron deficits were modeled using dosing tables and a joint distribution of bodyweight [mean 75.4 kg, standard deviation (SD) 17.4 kg] and hemoglobin (mean 10.8 g/dL, SD 1.4 g/dl) based on observational data from patients with IBD. Retreatment frequency was modeled using a pooled retrospective analysis of randomized trial data, and costs were modeled using diagnosis-related groups with an outpatient infusion cost of DKK 2855.


Using IIM required 1.2 infusions (per treatment) to correct the mean iron deficit compared with 1.6 with FCM. Treating 2.54 patients with IIM would therefore avoid one infusion compared with FCM. Patients using IIM required multiple infusions in 25.0% of cases compared with 64.3% with FCM. Over 5 years, total estimated costs were DKK 21,406 per patient with IIM compared with DKK 28,137 with FCM, corresponding to savings of DKK 6731 with IIM.


Using IIM in place of FCM markedly reduced the number of iron infusions required in patients with IBD and IDA in Denmark. The reduction in infusions was accompanied by reductions in cost compared with FCM.


Pharmacosmos A/S.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4


  1. 1.

    Loddo I, Romano C. Inflammatory bowel disease: genetics, epigenetics, and pathogenesis. Front Immunol. 2015;6:551.

    Article  Google Scholar 

  2. 2.

    Lophaven SN, Lynge E, Burisch J. The incidence of inflammatory bowel disease in Denmark 1980–2013: a nationwide cohort study. Aliment Pharmacol Ther. 2017;45(7):961–72.

    CAS  Article  Google Scholar 

  3. 3.

    Molodecky NA, Soon IS, Rabi DM, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012;142(46–54):e42.

    Google Scholar 

  4. 4.

    Odes S, Vardi H, Friger M, Wolters F, Russel MG, Riis L, Munkholm P, Politi P, Tsianos E, Clofent J, Vermeire S, Monteiro E, Mouzas I, Fornaciari G, Sijbrandij J, Limonard C, Van Zeijl G, O’Morain C, Moum B, Vatn M, Stockbrugger R. Cost analysis and cost determinants in a European inflammatory bowel disease inception cohort with 10 years of follow-up evaluation. Gastroenterology. 2006;131(3):719–28.

    Article  Google Scholar 

  5. 5.

    Kaitha S, Bashir M, Ali T. Iron deficiency anemia in inflammatory bowel disease. World J Gastrointest Pathophysiol. 2015;6(3):62–72.

    Article  Google Scholar 

  6. 6.

    WHO. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and mineral nutrition information system. World Health Organization, Geneva, Switzerland. 2011. Available form: Accessed 26 Jun 2018.

  7. 7.

    Dignass AU, Gasche C, Bettenworth D, et al. European Crohn’s and Colitis Organisation [ECCO]. European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases. J Crohns Colitis. 2015;9(3):211–22.

    Article  Google Scholar 

  8. 8.

    Aksan A, Işık H, Radeke HH, Dignass A, Stein J. Systematic review with network meta-analysis: comparative efficacy and tolerability of different intravenous iron formulations for the treatment of iron deficiency anaemia in patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2017;45(10):1303–18.

    CAS  Article  Google Scholar 

  9. 9.

    Bhandari S. Update of a comparative analysis of cost minimization following the introduction of newly available intravenous iron therapies in hospital practice. Ther Clin Risk Manag. 2011;7:501–9.

    Article  Google Scholar 

  10. 10.

    Koch TA, Myers J, Goodnough LT. Intravenous iron therapy in patients with iron deficiency anemia: dosing considerations. Anemia. 2015;2015:763576.

    Article  Google Scholar 

  11. 11.

    Kulnigg S, Stoinov S, Simanenkov V, et al. A novel intravenous iron formulation for treatment of anemia in inflammatory bowel disease: the ferric carboxymaltose (FERINJECT) randomized controlled trial. Am J Gastroenterol. 2008;103(5):1182–92.

    CAS  Article  Google Scholar 

  12. 12.

    Pollock RF, Kappelgaard AM, Seitz L. An analysis of product wastage arising from dosing increment granularity in four modern growth hormone administration devices. Expert Opin Drug Deliv. 2015;12(3):353–60.

    CAS  Article  Google Scholar 

  13. 13.

    Cheng HL, Bryant C, Cook R, O’Connor H, Rooney K, Steinbeck K. The relationship between obesity and hypoferraemia in adults: a systematic review. Obes Rev. 2012;13(2):150–61.

    CAS  Article  Google Scholar 

  14. 14.

    Electronic Medicines Compendium (eMC). Ferinject (ferric carboxymaltose) summary of product characteristics. Available from: Accessed 26 Jun 2018.

  15. 15.

    Frigstad SO, Haaber A, Bajor A, Fallingborg J, Hammarlund P, Bonderup OK, Blom H, Rannem T, Hellström PM. The NIMO Scandinavian Study: a prospective observational study of iron isomaltoside treatment in patients with iron deficiency. Gastroenterol Res Pract. 2017;2017:4585164.

    Article  Google Scholar 

  16. 16.

    Pollock RF, Muduma G. Intravenous iron treatments for iron deficiency anemia in inflammatory bowel disease: a budget impact analysis of iron isomaltoside 1000 (Monofer) in the UK. Expert Opin Drug Deliv. 2017;14(12):1439–46.

    CAS  Article  Google Scholar 

  17. 17.

    Kulnigg S, Teischinger L, Dejaco C, Waldhör T, Gasche C. Rapid recurrence of IBD-associated anemia and iron deficiency after intravenous iron sucrose and erythropoietin treatment. Am J Gastroenterol. 2009;104(6):1460–7.

    CAS  Article  Google Scholar 

  18. 18.

    Statistics Danmark. Folketal den 1. i kvartalet. 2018K2. Available from: Accessed 22 Jul 2018.

  19. 19.

    Jacobsen BA, Fallingborg J, Rasmussen HH, Nielsen KR, Drewes AM, Puho E, Nielsen GL, Sørensen HT. Increase in incidence and prevalence of inflammatory bowel disease in northern Denmark: a population-based study, 1978–2002. Eur J Gastroenterol Hepatol. 2006;18(6):601–6.

    Article  Google Scholar 

  20. 20.

    Molodecky NA, Soon IS, Rabi DM, Ghali WA, Ferris M, Chernoff G, Benchimol EI, Panaccione R, Ghosh S, Barkema HW, Kaplan GG. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012;142(1):46–54.

    Article  Google Scholar 

  21. 21.

    Burisch J, Jess T, Martinato M, Lakatos PL, ECCO-EpiCom. The burden of inflammatory bowel disease in Europe. J Crohns Colitis. 2013;7(4):322–37.

    Article  Google Scholar 

  22. 22.

    Filmann N, Rey J, Schneeweiss S, Ardizzone S, Bager P, Bergamaschi G, Koutroubakis I, Lindgren S, Morena Fde L, Moum B, Vavricka SR, Schröder O, Herrmann E, Blumenstein I. Prevalence of anemia in inflammatory bowel diseases in european countries: a systematic review and individual patient data meta-analysis. Inflamm Bowel Dis. 2014;20(5):936–45.

    Article  Google Scholar 

  23. 23.

    Sullivan SD, Mauskopf JA, Augustovski F, et al. Budget impact analysis-principles of good practice: report of the ISPOR 2012 budget impact analysis good practice II task force. Value Health. 2014;17(1):5–14.

    Article  Google Scholar 

  24. 24.

    Bhandari S. A hospital-based cost minimization study of the potential financial impact on the UK health care system of introduction of iron isomaltoside 1000. Ther Clin Risk Manag. 2011;7:103–13.

    Article  Google Scholar 

  25. 25.

    Olejaz M, Nielsen AJ, Rudkjøbing A, Birk HO, Krasnik A, Hernández-Quevedo C. Denmark: health system review. Health systems in transition. 2012;14(2):1–192. Available from: Accessed 18 Oct 2018.

Download references



Sponsorship for this study and the article publication charges were provided by Pharmacosmos A/S.


All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.


Richard F. Pollock is a full-time employee of Ossian Health Economics and Communications GmbH, which received consultancy fees to develop the budget impact model and conduct the Danish analysis. Gorden Muduma is a full-time employee of Pharmacosmos A/S, which is the EU marketing authorization holder for iron isomaltoside.

Compliance with Ethics Guidelines

This article does not include any studies of human participants or animals performed by any of the authors.

Data Availability

All data generated or analyzed during this study are included in this published article/as supplementary information files.

Author information



Corresponding author

Correspondence to Gorden Muduma.

Additional information

Enhanced Digital Features

To view enhanced digital features for this article go to

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Pollock, R.F., Muduma, G. An Economic Evaluation of Iron Isomaltoside 1000 Versus Ferric Carboxymaltose in Patients with Inflammatory Bowel Disease and Iron Deficiency Anemia in Denmark. Adv Ther 35, 2128–2137 (2018).

Download citation


  • Administration
  • Costs and cost analysis
  • Denmark
  • Intravenous
  • Iron
  • Iron deficiency anemia