Ferric carboxymaltose for patients with heart failure and iron deficiency in Italy: cost–effectiveness and budget impact
Publication: Journal of Comparative Effectiveness Research
Abstract
Aim: To evaluate the cost–effectiveness of intravenous ferric carboxymaltose (FCM) versus placebo for the management of iron deficiency in patients with chronic heart failure in the Italian healthcare system and to estimate its impact on the national healthcare budget. Materials & methods: A Markov model was developed to project costs and health outcomes over 1 year, based on data from literature. Healthcare resources consumption was derived from an e-survey administered to clinicians. Costs were obtained from official tariffs. Results: Treatment with FCM represents a dominant strategy compared with placebo, leading to national budget annual savings of 20–97 million Euros, according to different increasing utilization rates. Conclusion: FCM is a cost-saving option for the treatment of chronic heart failure patients with iron deficiency in Italy.
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References
Papers of special note have been highlighted as: • of interest; •• of considerable interest
1.
Ministero della Salute (2019). http://www.salute.gov.it/portale/salute/p1_5.jsp?lingua=italiano&id=43&area=Malattie_cardiovascolari
2.
Cowie MR, Anker SD, Cleland JGF et al. Improving care for patients with acute heart failure: before, during and after hospitalization. ESC Heart Fail. 1(2), 110–145 (2014).
3.
Go AS, Mozaffarian D, Roger VL et al. Heart disease and stroke statistics – 2013 update: a report from the American Heart Association. Circulation 127(1), e6–e245 (2013).
4.
Maggioni AP, Dahlström U, Filippatos G et al. EURObservational Research Programme: regional differences and 1-year follow-up results of the Heart Failure Pilot Survey (ESC-HF Pilot). Eur. J. Heart Fail. 15(7), 808–817 (2013).
5.
Klip IT, Comin-Colet J, Voors AA et al. Iron deficiency in chronic heart failure: an international pooled analysis. Am. Heart J. 165(4), 575.e3–582.e3 (2013).
6.
Jankowska EA, von Haehling S, Anker SD et al. Iron deficiency and heart failure: diagnostic dilemmas and therapeutic perspectives. Eur. Heart J. 34(11), 816–829 (2013).
7.
Okonko DO, Mandal AK, Missouris CG et al. Disordered iron homeostasis in chronic heart failure: prevalence, predictors, and relation to anemia, exercise capacity, and survival. J. Am. Coll. Cardiol. 58(12), 1241–1251 (2011).
8.
Ponikowski P, van Veldhuisen DJ, Comin-Colet J et al. Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency. Eur. Heart J. 36, 657–668 (2015).
•• Clinical study comparing ferric carboxymaltose (FCM) to placebo.
9.
Gutzwiller FS, Schwenkglenks M, Blank PR et al. Health economic assessment of ferric carboxymaltose in patients with iron deficiency and chronic heart failure based on the FAIR-HF trial: an analysis for the UK. Eur. J. Heart Fail. 14(7), 782–790 (2012).
• European cost–effectiveness analysis.
10.
Comín-Colet J, Enjuanes C, González G et al. Iron deficiency is a key determinant of health-related quality of life in patients with chronic heart failure regardless of anaemia status. Eur. J. Heart Fail. 15(10), 1164–1172 (2013).
11.
Anker SD, Comin Colet J, Filippatos G et al. Ferric carboxymaltose in patients with heart failure and iron deficiency. N. Engl. J. Med. 361, 2436–2448 (2009).
•• Clinical study comparing FCM to placebo.
12.
Arutyunov G. The safety of intravenous (IV) ferric carboxymaltose versus IV iron sucrose on patients with chronic heart failure (CHF) and chronic kidney disease (CKD) with iron deficiency (ID). Eur. J. Heart Fail. 8, ii71 (2009).
•• Clinical study comparing FCM to placebo.
13.
Effect of ferric carboxymaltose on exercise capacity and cardiac function in patients with iron deficiency and chronic heart failure (EFFICACY-HF) (data on file). US National Institutes of Health (2009). https://clinicaltrials.gov/ct2/show/NCT00821717
•• Clinical study comparing FCM to placebo.
14.
Ponikowski P, Voors AA, Anker SD et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur. Heart J. 37(27), 2129–2200 (2016).
15.
Theidel U, Väätäinen S, Martikainen J, Soini E, Hardt T, Doehner W. Budget impact of intravenous iron therapy with ferric carboxymaltose in patients with chronic heart failure and iron deficiency in Germany. ESC Heart Fail. 4(3), 274–281 (2017).
•• Reference study for the developed model.
16.
Anker SD, Kirwan BA, van Veldhuisen DJ et al. Effects of ferric carboxymaltose on hospitalisations and mortality rates in iron-deficient heart failure patients: an individual patient data meta-analysis. Eur. J. Heart Fail. 20(1), 125–133 (2018).
17.
Husereau D, Drummond M, Petrou S et al. Consolidated health economic evaluation reporting standards (CHEERS) – explanation and elaboration: a report of the ISPOR health economic evaluations publication guidelines good reporting practices task force. Value Health 16, 231–250 (2013).
18.
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 17(1), 5–14 (2014).
19.
Esmé G, Trevelyan J, Robinson C. Delphi methodology in health research: how to do it? Eur. J. Integr. Med. 7(4), 423–428 (2015).
20.
La rete cardiologica per la cura del malato con scompenso cardiaco: organizzazione dell'assistenza ambulatoriale (2016). http://www.anmco.it/uploads/u_cms/media/2016/6/69730b48ccd65dce09bf23dae9ef32fb.pdf
21.
Federfarma (2019). http://www.federfarma.it
22.
Piccinni C, Antonazzo IC, Simonetti M et al. The burden of chronic heart failure in primary care in Italy. High Blood Press. Cardiovasc. Prev. 24(2), 171–178 (2017).
23.
D'ambrosio G. La gestione dei pazienti con scompenso cardiaco in Medicina Generale: i risultati preliminari di un audit condotto per via telematica. Esperienze e ricerche in Medicina Generale. Società Italiana di Medicina Generale. Rivista della Società Italiana di Medicina Generale. N.4, AgostoAugust 2010 (2010). https://www.simg.it/documenti/rivista/2010/04_2010/3.pdf
24.
von Haehling S, Gremmler U, Krumm M et al. Prevalence and clinical impact of iron deficiency and anaemia among outpatients with chronic heart failure: The PrEP Registry. Clin. Res. Cardiol. 106(6), 436–443 (2017).
25.
Garattini L, Castelnuovo E, Lanzeni D, Viscarra C. Durata e costo delle visite in medicina generale: il progetto DYSCO. (Duration and cost of GP visits). Farmeconomia e percorsi terapeutici 4(2), 109–114 (2003).
26.
Calvert MJ, Freemantle N, Yao G et al. Cost–effectiveness of cardiac resynchronization therapy: results from the CARE-HF trial. Eur. Heart J. 26(24), 2681–2688 (2005).
27.
Kirsch J, McGuire A. Establishing health state valuations for disease specific states: an example from heart disease. Health Econ. 9(2), 149–158 (2000).
28.
Griffiths A, Paracha N, Davies A et al. The cost–effectiveness of ivabradine in the treatment of chronic heart failure from the UK National Health Service perspective. Heart 100(13), 1031–1036 (2014).
29.
Göhler A, Geisler BP, Manne JM et al. Utility estimates for decision-analytic modeling in chronic heart failure – health states based on New York Heart Association classes and number of rehospitalizations. Value Health 12(1), 185–187 (2009).
30.
Lewis EF, Johnson PA, Johnson W et al. Preferences for quality of life or survival expressed by patients with heart failure. J. Heart Lung Transplant. 20(9), 1016–1024 (2001).
31.
Smith B, Hughes-Cromwick PF, Forkner E, Galbreath AD. Cost–effectiveness of telephonic disease management in heart failure. Am. J. Manag. Care 14(2), 106–115 (2008).
32.
Ponikowski P, Anker SD, AlHabib KF et al. Heart failure: preventing disease and death worldwide. ESC Heart Fail. 1, 4–25 (2014).
33.
Comín-Colet J, Rubio-Rodríguez D, Rubio-Terrés C 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.) 68(10), 846–851 (2015).
• European cost–effectiveness analysis.
34.
Hofmarcher T, Borg S. Cost–effectiveness analysis of ferric carboxymaltose in iron-deficient patients with chronic heart failure in Sweden. J. Med. Econ. 18(7), 492–501 (2015).
• European cost–effectiveness analysis.
35.
Hofmarcher T, Cabrales Alin D, Linde C. Cost–effectiveness of implementing ESC guidelines for treatment of iron deficiency in heart failure in the Nordic countries. Scand. Cardiovasc. J. 52(6), 348–355 (2018).
• European cost–effectiveness analysis.
36.
European Network for Health Technology Assessment (EUnetHTA) (2019). www.eunethta.eu
37.
Wolf M, Chertow GM, Macdougall IC et al. Randomized trial of intravenous iron-induced hypophosphatemia. JCI Insight 3(23), pii: 124486 (2018).
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Pages: 1099 - 1110
PubMed: 31580153
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© 2019 Carla Rognoni. This work is licensed under a Creative Commons Attribution-NonCommercial NonDerivative 4.0 Unported License
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Received: 12 June 2019
Accepted: 15 August 2019
Published online: 3 October 2019
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Ferric carboxymaltose for patients with heart failure and iron deficiency in Italy: cost–effectiveness and budget impact. (2019) Journal of Comparative Effectiveness Research. DOI: 10.2217/cer-2019-0074
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