A UK Cost-Utility Analysis of Ferric Carboxymaltose Versus Ferric Derisomaltose in Patients with Iron Deficiency Anemia and Inflammatory Bowel Disease: Incorporation of Fracture Data

OBJECTIVES: Ferric derisomaltose (FDI) has been shown to improve patient quality of life and reduce healthcare costs versus ferric carboxymaltose (FCM) in treating anemia associated with inflammatory bowel disease (IBD), driven by different posology and lower hypophosphatemia risk. Recent European data suggests similar fracture rates before and after administration of FDI compared to an increased fracture risk after administration of FCM. This analysis updates a prior cost-utility analysis (CUA) of IV iron in the United Kingdom to incorporate the distinct fracture profiles of FDI and FCM.

METHODS: Fracture data for 110 and 179 patients who received FDI and FCM, respectively, were used to derive parametric survival models of fracture-free survival after first intravenous iron administration. The best fitting models were selected and incorporated into a previously-published patient-level simulation model. Fracture disutilities were obtained from the literature, and fracture costs were derived from the National Schedule of NHS costs. The analysis was run over a 10-year time horizon and discounted at 3.5% annually.

RESULTS: Observed first fracture rates were 0.455 per 100 person-years with FDI versus 0.997 with FCM. Over 10 years, FDI resulted in 4.85 quality-adjusted life-years (QALYs) versus 4.70 with FCM, an increase of 0.157 QALYs. Differences in fracture incidence accounted for 13.8% of the overall QALY difference. Total per-patient costs were GBP 3,261 with FDI and GBP 4,831 for FCM; FDI was therefore the dominant intervention. Based on a weighted per-fracture cost of £4,982 in the index year, fractures contributed GBP 122 to total costs with FDI versus GBP 442 with FCM.

CONCLUSIONS: FDI was found to improve quality-of-life and reduce healthcare costs versus FCM in the treatment of IBD-associated anemia in the UK. Relative to a previous UK CUA in which FDI dominated FCM, the inclusion of fractures resulted in further cost savings and QALY benefits with FDI versus FCM.