Impact of COVID-19 Pandemic on IV Iron (IVI) Cost and Utilization in Commercially-Insured Patients With Iron Deficiency Anemia (IDA)

OBJECTIVES: Understand the impact of COVID-19 pandemic on IV iron (IVI) cost and utilization in commercially-insured patients with iron deficiency anemia (IDA).

METHODS: A retrospective, longitudinal analysis of commercial administrative claims data from Komodo’s Healthcare Map included adult patients with a diagnosis of IDA within 6 months of index date (date of first IVI infusion) and an IVI treatment claim between January 2017 and July 2021. Patients on hemodialysis, with an IVI claim during the baseline period, or utilizing hospice services were excluded. IVI products evaluated were grouped as older generation (FDA-approved before 2009) and newer generation. Patients were assigned to the 6-month period in which the index date occurred. Total cost of care (TCoC) and discordance were evaluated; discordance was defined as having received less than 1,000 mg of IVI in the 6-week index treatment course.

RESULTS: About 23,000 patients were included in each period. Overall patient demographics were similar; about 86% were female and the average age was 45 years. The Charlson Comorbidity Index trended higher during the pandemic at around 1.41 compared to 1.26 before, and then normalized thereafter. Percent utilization of newer generation IVI increased until the second half of 2019, then decreased. After inflation adjustment, the mean total cost of care (TCoC) increased by 31% overall. Discordance to IVI treatment declined (proportional to increased utilization of newer IVIs) until the second half of 2019 and then increased; mean overall discordance was 34.6%.

CONCLUSIONS: The COVID-19 pandemic generally had a minimal impact on cost and utilization of IVIs, with consistent increases in TCoC across IVIs. Distinct change in utilization began in the first half of 2020, reflecting the shift in payor management of IVIs. Implementation of payor restrictions resulted in a proportional decline in concordance, negating any positive impacts of utilizing newer generation products, which generally require fewer infusions.