A Cost-Utility Analysis of Ferric Derisomaltose Versus Ferric Carboxymaltose in Patients With Inflammatory Bowel Disease in Italy

OBJECTIVES:

Anemia is the most common extraintestinal complication of inflammatory bowel disease (IBD), with approximately half of cases caused by iron deficiency (ID). Intravenous (IV) iron is the preferred ID anemia (IDA) treatment where oral iron is contraindicated, ineffective or not tolerated, or where correction of ID is urgent. The recent PHOSPHARE-IBD randomized controlled trial (RCT; ClinialTrials.gov ID NCT03466983) reported significantly higher incidence of hypophosphatemia after treatment with ferric carboxymaltose (FCM) than ferric derisomaltose (FDI). The present study objective was to evaluate the cost-utility of FDI versus FCM in patients with IBD in Italy.

METHODS:

A patient-level simulation model was developed to evaluate the cost-utility of FDI versus FCM, capturing differences in quality of life based on SF-36 data from PHOSPHARE-IBD, monitoring and incidence of post-infusion hypophosphatemia, and number of iron infusions required. The analysis was conducted over a five-year time horizon from a national payer perspective. Costs in the analysis were based on diagnosis-related groups (DRGs), which covered both infusion and drug costs. Future costs and effects were discounted at 3.5% per annum. One-way and probabilistic sensitivity analyses were performed.

RESULTS:

Compared with FCM, FDI increased quality-adjusted life expectancy by 0.075 QALYs from 2.57 QALYs to 2.65 QALYs. Patients treated with FDI also required 1.52 fewer iron infusions over the five-year time horizon, driving infusion-related cost savings of €310 per patient (€1,467 versus €1,157). Costs of monitoring and treating hypophosphatemia after treatment with FCM were €169, resulting in total cost savings of €478 per patient treated with FDI (€1,635 versus €1,157). FDI was therefore the dominant intervention.

CONCLUSIONS:

The analysis showed that FDI would improve patient quality of life and reduce direct healthcare expenditure versus FCM in patients with IBD in Italy. Cost savings with FDI were driven by reductions in iron infusions and hypophosphatemia monitoring and treatment.