OBJECTIVES: Hip surgery is associated with considerable blood loss and high rates of peri-operative blood transfusion. Peri-operative anemic patients are often associated with allogeneic transfusion events; increased rates of infections, numbers of cardiac complications, hospital days; and more deaths. We examined costs of a treatment protocol change facilitated by post-operative single high dose intravenous ferric carboxymaltose (FCM) 1000mg administration, associated with a reduction of transfusion amounts and length of hospital stay (LOS) at a tertiary hospital in Korea.

METHODS: This cost-minimization analysis (CMA) study compared treatment costs between the Protocol change group with FCM and the Control group, assuming that health outcomes of both groups were equivalent. The clinical efficacy was based on Kim et al. 2018 study that evaluated 300 patients with Hb <10g/dL post-operative or Hb concentration >3g/dL lower than preoperative Hb level in Korea. Direct medical costs such as hospitalization cost, consultation fee, transfusion cost, etc. were applied using HIRA data.

RESULTS: The Protocol change group with FCM showed cost savings comparing to the Control group by reducing transfusion amount and LOS associated costs. Treatment costs per patient of the Protocol change group with FCM vs. the Control group were 879,269 KRW vs. 1,247,155 KRW respectively, demonstrating FCM saved healthcare cost of 367,886 KRW. The sensitivity analysis showed that the difference in length of hospital stay between groups was the main factor.

CONCLUSIONS: After orthopedic hip surgery, the Protocol change with FCM supports optimal health care resource utilization as well as clinical benefits by reducing the length of hospital days and transfusion amounts by improving Hb levels. These savings estimates are conservative given the regular challenge of maintaining blood supply management as well as improving outcomes that result from reducing the risk of transfusion and if FCM were used earlier in the protocol such as preoperatively.