Cost-Effectiveness of Ferric Carboxymaltose in the Treatment of Iron-Deficiency Anemia in Pregnant Women

OBJECTIVES: This study aims to assess the cost-effectiveness of ferric carboxymaltose (FCM) compared to iron sucrose complex (ISC) in the treatment of iron-deficiency anemia in pregnant women from the perspective of a Brazilian private health insurance company.

METHODS: Cost-effectiveness analysis was conducted using a decision tree model. The effectiveness variable was extracted from a systematic search for relevant clinical studies evaluating outcomes: hemoglobin normalization (Hb ≥110) and elevation in relation to the baseline value. Cost data were derived from the internal database from October/2022 to September/2023. Additionally, a deterministic sensitivity analysis was performed.

RESULTS: No serious adverse events were reported, therefore their impact on costs was not considered in the analysis. For both outcomes, over a time horizon of 12 weeks FCM demonstrated superiority, with 82% vs. 70% for Hb normalization and 29.6 ± 8.2 g/L vs. 22.1 ± 8.2 g/L for elevation from baseline (FCM: 85.7±8.9 and ISC: 86.7±8.6 g/L). Total costs encompassed medication acquisition and infusion costs for treatment (FCM 2.0±0 doses of 1,000mg and ISC 6.04±0.45 doses of 300mg), totalizing US$497.24 and US$265.99, respectively. The incremental cost-effectiveness ratio (ICER) of FCM for anemia resolution and Hb elevation over 12 weeks was US$1,927.03 and US$30.83, respectively. Parameters most influencing cost-effectiveness were FCM acquisition cost, followed by ISC infusion costs.

CONCLUSIONS: The significance of treating iron-deficiency anemia in pregnant women lies in the elevated risk of fetal complications, premature birth, and maternal mortality. Analysis results suggest that, despite the incremental cost associated with FCM use, its superior efficacy and favorable ICER, which falls below Brazil's 2022 GDP per capita, support its economic viability compared to conventional treatment.