FRACTURE-RELATED COSTS OF HIGH-DOSE INTRAVENOUS IRON FORMULATION CHOICE: AUSTRIAN AND US REAL-WORLD EVIDENCE TRANSFERRED TO THE GERMAN HEALTHCARE SYSTEM
Author(s)
Dirk Laufer, PhD1, Mathias Flume, PhD2, Julian Witte, PhD3, Andreas Wöhrmann, PhD4.
1Universitätsklinikum Bonn, Bonn, Germany, 2GeneAccess GmbH, Dortmund, Germany, 3VANDAGE, Bielefeld, Germany, 4Pharmacosmos GmbH, Wiesbaden, Germany.
1Universitätsklinikum Bonn, Bonn, Germany, 2GeneAccess GmbH, Dortmund, Germany, 3VANDAGE, Bielefeld, Germany, 4Pharmacosmos GmbH, Wiesbaden, Germany.
OBJECTIVES: Modern high-dose intravenous (IV) iron formulations achieve comparable haematologic efficacy; safety and cost therefore drive formulation choice. Ferric carboxymaltose (FCM) has recently been associated with a higher fracture risk than ferric derisomaltose (FDI), with which fracture risk appeared unchanged. We estimated the fracture-related direct costs potentially avoidable in Germany, per patient and nationally.
METHODS: A published FCM-versus-FDI fracture rate ratio of 2.03 (Wagner et al. 2026) was applied to German age- and sex-specific inpatient fracture incidence (Rupp et al. 2021, Destatis-based; all-site 1,014/100,000, rising from ~520 below age 70 to ~3,060 at ≥70), taken as the baseline/FDI rate; the FCM rate was baseline × 2.03. The excess (baseline × 1.03) was applied to the entire treated population, weighted by an assumed age/sex structure (35% aged ≥70). Excess fractures were costed with German 2025 DRGs: a site-weighted EUR 5,521 (proximal-femoral-fracture averaging EUR 7,067 including nursing for major sites; EUR 3,000 for minor sites). German exposure (IQVIA MIDAS/Pharmascope 2025) gave 5.24 million standardised 100-mg units (FCM 94.8%) and ~497,000 FCM patients/year; analyses took a national statutory-payer perspective on direct inpatient costs (one-year horizon).
RESULTS: Annually, the FCM-attributable excess amounted to ~1.5% additional fractures and ~EUR 80 per patient, or ~7,200 avoidable fractures and ~EUR 40 million nationally. Across reported fracture rate ratios of 1.5 to 3.08 (Wagner et al.), estimates ranged ~EUR 39-162 per patient and ~EUR 19-80 million nationally per year.
CONCLUSIONS: Using German age- and sex-matched general-population fracture rates with a published rate ratio, the formulation-dependent fracture risk corresponds to a measurable per-patient and national direct-cost difference. Estimates remain exploratory and depend chiefly on the treated population's age structure, which German statutory-health-insurance claims data would refine; excluding rehabilitation and long-term care, the estimate is conservative.
METHODS: A published FCM-versus-FDI fracture rate ratio of 2.03 (Wagner et al. 2026) was applied to German age- and sex-specific inpatient fracture incidence (Rupp et al. 2021, Destatis-based; all-site 1,014/100,000, rising from ~520 below age 70 to ~3,060 at ≥70), taken as the baseline/FDI rate; the FCM rate was baseline × 2.03. The excess (baseline × 1.03) was applied to the entire treated population, weighted by an assumed age/sex structure (35% aged ≥70). Excess fractures were costed with German 2025 DRGs: a site-weighted EUR 5,521 (proximal-femoral-fracture averaging EUR 7,067 including nursing for major sites; EUR 3,000 for minor sites). German exposure (IQVIA MIDAS/Pharmascope 2025) gave 5.24 million standardised 100-mg units (FCM 94.8%) and ~497,000 FCM patients/year; analyses took a national statutory-payer perspective on direct inpatient costs (one-year horizon).
RESULTS: Annually, the FCM-attributable excess amounted to ~1.5% additional fractures and ~EUR 80 per patient, or ~7,200 avoidable fractures and ~EUR 40 million nationally. Across reported fracture rate ratios of 1.5 to 3.08 (Wagner et al.), estimates ranged ~EUR 39-162 per patient and ~EUR 19-80 million nationally per year.
CONCLUSIONS: Using German age- and sex-matched general-population fracture rates with a published rate ratio, the formulation-dependent fracture risk corresponds to a measurable per-patient and national direct-cost difference. Estimates remain exploratory and depend chiefly on the treated population's age structure, which German statutory-health-insurance claims data would refine; excluding rehabilitation and long-term care, the estimate is conservative.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE385
Topic
Economic Evaluation, Medical Technologies, Real World Data & Information Systems
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Oncology