Impact of Intravenous Iron Replacement Therapy on Healthcare Costs for Patients with Iron Deficiency Anemia in the USA: A Retrospective Analysis

Abstract

Background: Intravenous iron replacement therapy for the treatment of iron deficiency anemia is often required in patients with chronic diseases including cancer, heart failure, or chronic kidney disease.

Objective: We aimed to compare healthcare resource utilization and costs for patients treated with intravenous ferric carboxymaltose (FCM) or low-dose iron for iron deficiency anemia.

Methods: This analysis of Optum Research Database administrative claims data included patients with iron deficiency anemia who received intravenous iron from 2017 to 2019 and had diagnoses of cancer, heart failure, or chronic kidney disease. Patients were continuously enrolled for 6-month baseline and 12-month follow-up periods. Follow-up all-cause total costs for FCM and low-dose iron cohorts were compared using generalized linear models; inpatient costs were estimated with two-part models to account for patients without hospitalizations. Models were adjusted for age, sex, geographic region, insurance type, index year, baseline comorbidity scores, and healthcare costs. Sensitivity analyses compared FCM with an iron sucrose subgroup.

Results: For patients with cancer (n = 10,763), mean adjusted all-cause total costs were numerically lower for FCM than low-dose iron by $2369 (cost ratio [CR] 0.97, P = 0.182) and significantly lower for FCM than iron sucrose by $6712 (CR 0.93, P < 0.001). For heart failure (n = 8337), the mean all-cause total cost was numerically lower for FCM than low-dose iron by $2022 (CR 0.97, P = 0.198) and significantly lower for FCM than iron sucrose by $3892 (CR 0.95, P = 0.024). For chronic kidney disease (n = 10,617), the mean all-cause total cost was statistically significantly lower for FCM than low-dose iron by $3623 (CR 0.94, P = 0.006) and iron sucrose by $4161 (CR 0.93, P = 0.004). For all groups, the FCM and low-dose iron cohorts differed in both the odds of having any inpatient costs and the level of inpatient cost (cancer: odds ratio 0.79, P < 0.001; CR 0.88, P < 0.001; heart failure: odds ratio 0.76, P < 0.001; CR 0.89, P < 0.001; chronic kidney disease: odds ratio 0.75, P < 0.001; CR 0.84, P < 0.001). Inpatient cost results were consistent for iron sucrose.

Conclusions: Despite the typically higher drug acquisition cost of FCM versus low-dose intravenous iron, the price differential was offset by the lower inpatient cost incurred in the FCM cohort in each patient population. These findings suggest the potential economic benefit of FCM to reduce inpatient utilization and associated costs to patients and health plans compared with low-dose intravenous iron.

Fig. 1

Unadjusted follow-up all-cause healthcare costs^a. CKD chronic kidney disease, ED emergency department, FCM ferric carboxymaltose, HF heart failure, USD US dollars. ^aTotals were calculated prior to rounding for subcategories

Fig. 2

Adjusted annual healthcare costs during the follow-up period: patients with cancer (A), heart failure [HF] (B), and chronic kidney disease [CKD] (C). FCM ferric carboxymaltose, IV intravenous, USD United States dollars

Fig. 3

Iron deficiency anemia-related costs in the 12-month follow-up period^a. CKD chronic kidney disease, ED emergency department, FCM ferric carboxymaltose, HF heart failure, USD United States dollars. ^aCosts were defined as iron deficiency anemia related if the claim had a diagnosis for iron deficiency anemia in any position on the claim or was a medical claim for intravenous iron therapy