Abstract
Background In Australia, iron deficiency anaemia can be managed by ferric carboxymaltose, and iron polymaltose given via either a traditional slow or new rapid infusion protocol. These differ in their manufacturing, administration, and monitoring requirements, with unknown associated costs. Aim To compare the direct costs of iron infusions used in Australia; and explore potential savings associated with increased uptake of the least-expensive option at a local hospital. Method A time-motion method was used to determine the labour and consumables associated with each infusion protocol. Secondly, a frequency analysis identified the most common iron infusion doses prescribed at the study site. The total direct costs per protocol were compared at these doses and then the potential savings from switching to the lowest-costing of these protocols where possible were explored. Results The most common doses were 0.5 g, 1 g, 1.5 g and 2 g. At these dose points, ferric carboxymaltose infusions are the least expensive, but only if national health subsidies are applied. In cases where they do not apply, iron polymaltose prepared from ampoules and infused using the rapid protocol (‘Iron Polymaltose Ampoules Rapid’) is the least expensive. Switching all applicable ferric carboxymaltose infusions and iron polymaltose infusions administered using the slow infusion protocol to Iron Polymaltose Ampoules Rapid is projected to yield up to $12,000 worth of savings annually. Conclusions Increased use of the Iron Polymaltose Ampoules Rapid protocol when government-subsidised options are not available is projected to have cost-saving outcomes. Investigation of implementation strategies to increase the use of this protocol are warranted.
Similar content being viewed by others
References
Kassebaum NJ, Jasrasaria R, Naghavi M, Wulf S, Johns N, Lozano R, et al. A systematic analysis of global anemia burden from 1990 to 2010. Blood. 2014;123:615–24.
eTG Complete [Internet]. Parenteral Iron Supplementation. West Melbourne: Therapeutic Guidelines Ltd; 2016 [accessed 14.07.2018]. Available from: https://tgldcdp.tg.org.au/viewTopic?topicfile=iron-deficency&guidelineName=Gastrointestinal#toc_d1e234
Geisser P, Banke-Bochita J. Pharmacokinetics, safety and tolerability of intravenous ferric carboxymaltose: a dose-escalation study in volunteers with mild iron-deficiency anaemia. Arzneimittelforschung. 2010;60:362–72.
Newnham E, Ahmad I, Thornton A, Gibson PR. Safety of iron polymaltose given as a total dose iron infusion. Intern Med J. 2006;36:672–4.
Qassim A, Gergis RG, Jeffries B, Grivell RM, Grzeskowiak LE. Use of intravenous iron polymaltose in the management of iron deficiency in pregnancy: a retrospective cohort study. Aust N Z J Obstet Gynaecol. 2018;58:163–9.
Qassim A, Mol BW, Grivell RM, Grzeskowiak LE. Safety and efficacy of intravenous iron polymaltose, iron sucrose and ferric carboxymaltose in pregnancy: a systematic review. Aust N Z J Obstet Gynaecol. 2018;58:22–39.
Handbook AID. Iron Polymaltose Complex. 7th ed. Collingwood: Society of Hospital Pharmacists of Australia; 2017.
Department of Health and Human Services. Iron Polymaltose Infusion. Royal Hobart Hospital, Tasmania; 2016.
Handbook AID. Ferinject. 7th ed. Collingwood: Society of Hospital Pharmacists; 2017.
Wilson R. Ferric Carboxymaltose (Ferinject)—A NEW I.V. Iron Formulation. Royal Hobart Hospital, Tasmania; 2014.
Pasricha SR, Flecknoe-Brown SC, Allen KJ, Gibson PR, McMahon LP, Olynyk JK, et al. Diagnosis and management of iron deficiency anaemia: a clinical update. Med J Aust. 2010;193:525–32.
Banakh I, Lam A, Turek M, Htet T, Vorlander C. Rapid versus standard iron polymaltose infusions: a single centre safety study. J Pharm Prac Res. 2017;47:103–9.
Garg M, Morrison G, Friedman A, Lau A, Lau D, Gibson PR. A rapid infusion protocol is safe for total dose iron polymaltose: time for change. Intern Med J. 2011;41:548–54.
Manoharan A, Alexander W, Ramakrishna R, Legge J, Uebel J. Comparative rates of adverse events with 2-hour versus 4-hour infusion of total dose intravenous iron polymaltose. Int J Clin Med. 2014;5:145–8.
Chan PTY, Corallo CE, Dooley MJ, Poole SG, Gibson PR. Safety of rapid infusion of iron polymaltose: comparative study in 300 patients. J Pharm Prac Res. 2016;46:324–30.
Lim EA, Sohn HS, Lee H, Choi SE. Cost-utility of ferric carboxymaltose (Ferinject®) for iron-deficiency anemia patients with chronic heart failure in South Korea. Cost Eff Resour Alloc. 2014;12:19.
Comín-Colet J, Rubio-Rodríguez D, Rubio-Terrés C, Enjuanes-Grau C, Gutzwiller FS, Anker SD, et al. A cost-effectiveness analysis of ferric carboxymaltose in patients with iron deficiency and chronic heart failure in Spain. Rev Esp Cardiol (Engl Ed). 2015;68:846–51.
Bourguignon S, Faller M, Champs FO, Moutier H, Levesque K, Caranhac G, et al. Budget impact of intravenous ferric carboxymaltose in patients with chronic heart failure and iron deficiency in France. ESC Heart Fail. 2019;6:559–69.
Hofmarcher T, Borg S. Cost-effectiveness analysis of ferric carboxymaltose in iron-deficient patients with chronic heart failure in Sweden. J Med Econ. 2015;18:492–501.
Delgado JF, Oliva J, González-Franco Á, Cepeda JM, Garcia-Garcia JA, Gonzalez-Dominguez, et al. Budget impact of ferric carboxymaltose treatment in patients with chronic heart failure and iron deficiency in Spain. J Med Econ. 2020;23:1418–24.
Delpeuch A, Ruivard M, Abergel A, Aumaitre O, Boisgard S, Bagel S, et al. Financial impact of intravenous iron treatments on the management of anaemia inpatients: a 1 year observational study. Int J Clin Pharm. 2018;40:686–92.
Pollock RF, Muduma G. A patient-level cost-effectiveness analysis of iron isomaltoside versus ferric carboxymaltose for the treatment of iron deficiency anemia in the United Kingdom. J Med Econ. 2020;23:751–9.
Pollock RF, Muduma G. An economic analysis of ferric derisomaltose versus ferric carboxymaltose in the treatment of iron deficiency anemia in patients with inflammatory bowel disease in Norway, Sweden, and Finland. Clinicoecon Outcomes Res. 2021;13:9–18.
Bager P, Dahlerup JF. The health care cost of intravenous iron treatment in IBD patients depends on the economic evaluation perspective. J Crohns Colitis. 2010;4:427–30.
Florea NR, Kotapati S, Kuti JL, Geissler EC, Nightingale CH, Nicolau DP. Cost analysis of continuous versus intermittent infusion of piperacillin-tazobactam: a time-motion study. Am J Health Syst Pharm. 2003;60:2321–7.
Plumridge RJ. Cost analysis of infusion versus injection delivery of imipenem/cilastatin and meropenem. Clini Drug Investig. 1997;14:132–6.
Pharmaceutical Benefits Scheme. Iron Polymaltose [Internet]. Canberra (ACT): Pharmaceutical Benefits Scheme; ND [accessed 07.10.2019]. Available from: http://www.pbs.gov.au/medicine/item/2593L-2805P.
Pharmaceutical Benefits Scheme. Ferric Carboxymaltose [Internet]. Canberra (ACT): Pharmaceutical Benefits Scheme; ND [accessed 20.07.2018]. Available from: http://www.pbs.gov.au/medicine/item/10104T.
Auerbach M, Gafter-Gvili A, Macdougall IC. Intravenous iron: a framework for changing the management of iron deficiency. Lancet Haematol. 2020;7:e342–50.
Khalafallah AA, Hyppa A, Chuang A, Hanna Fayez, Wilson E, Kwok C, et al. A prospective randomised controlled trial of a single intravenous infusion of ferric carboxymaltose vs single intravenous iron polymaltose or daily oral ferrous sulphate in the treatment of iron deficiency anaemia in pregnancy. Semin Hematol. 2018;55:223–34.
Shand AW, Bell J, Henry A, Grzeskowiak LE, Kidson-Gerber G, Pearson S, et al. Rapid increase in intravenous iron therapy for women of reproductive age in Australia. Med J Aust. 2020;213:85–6.
Gilmartin CE, Hoang T, Cutts BA, Leung L. Retrospective cohort study comparing the adverse reactions and efficacy of intravenous iron polymaltose with ferric carboxymaltose for iron deficiency anemia. Int J Gynaecol Obstet. 2018;141:315–20.
Acknowledgements
We would like to thank pharmacy and nursing staff at the Royal Hobart Hospital for their invaluable assistance with this project.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
The authors have declared no potential conflicts of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Lim, C.K., Connolly, M. & Mirkazemi, C. A budget impact analysis of iron polymaltose and ferric carboxymaltose infusions. Int J Clin Pharm 44, 110–117 (2022). https://doi.org/10.1007/s11096-021-01320-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11096-021-01320-4