Enhancing Oncology Model: Discordance Among Patients Using Intravenous Iron in the US

OBJECTIVES: Evaluate incomplete treatment among intravenous iron (IVI) products in patients with iron deficiency anemia (IDA) and Enhancing Oncology Model (EOM) tumor types.

METHODS: This retrospective study utilized Komodo Health's administrative claims data from patients enrolled in Medicare health plans. Patients were required to have a diagnosis of IDA and one of the 7 EOM tumor types 6 months prior to index date (date of first IVI infusion) and treated with an IVI product from 01/01/2020–09/30/2022. Patients receiving hemodialysis were excluded. Evaluated IVI products included iron dextran (ID), iron sucrose (IS), sodium ferric gluconate (SFG), ferric carboxymaltose (FCM), ferumoxytol (FXT), and ferric derisomaltose (FDI). Discordance, a surrogate marker for nonadherence, was assessed for each patient and defined as having received less than 1,000 mg of IVI (commonly targeted clinical dose for a course of treatment for IDA) over 6 weeks.

RESULTS: This study included 6,450 patients. Patients had an average age of 73.3 years and 56.8% of patients identified as female. The Charlson Comorbidity Index was similar among the cohorts (average 6.0). Discordance to IVI therapy was 32.4% overall and as follows for each IVI product: 38.9% (ID), 71.0% (IS), 90.8% (SFG), 24.6% (FCM), 17.1% (FXT), and 0.0% (FDI).

CONCLUSIONS: EOM aims to generate cost savings and improve quality of care for cancer patients undergoing chemotherapy based on 6-month episodes of care across 7 specific tumor types. Overall, IVI products requiring multiple infusions for iron replacement saw greater discordance per treatment course. If oncology practices are being held accountable for quality of care, then restricting IVI selection solely on drug cost is counterproductive to supporting EOM as it leads to potential undertreatment of IDA (< 1,000 mg received). IVI product selection should ensure that discordance, patient preference, health-related social needs, and outcomes are not ignored in EOM practices.