OBJECTIVES: The AFFIRM-AHF trial established intravenous ferric carboxymaltose (FCM) as safe and effective therapy compared with placebo for reducing the risk of hospitalisations for heart failure (HHF) in patients stabilized after an acute heart failure episode with reduced ejection fraction (HFrEF) and iron deficiency (ID). The objective of this analysis was to estimate the event and cost consequence of introducing FCM for the treatment of ID in patients with HFrEF from the perspective of healthcare payers in the United States.

METHODS: A de novo cost-offset model was built to estimate the impact of introducing FCM for the treatment of ID in HFrEF patients over a five-year time horizon in the US. The eligible patient population was estimated from aggregate National Inpatient Sample data to identify a hospitalized HFrEF population. ID was assumed in 33.7% of these patients from a published report in another setting. Rates of HHF were sourced from AFFIRM-AHF and costs from published literature. Linear regression was used to evaluate the relationship between treatment uptake and events avoided and costs savings accrued.

RESULTS: In total, an estimated 26,202 patients were admitted with HFrEF and ID. Without treatment, these individuals were estimated to incur 29,948 HHF-related bed days over five years with an associated cost of $819.8 million. Per 1,000 patients, treatment with FCM was associated with a reduction in HHF-related bed days of 219 days over five years corresponding to cost savings of $6.0 million. Scenario analysis where all 26,202 patients were treated resulted in a reduction in total HHF-related bed days of 5,744 days and an associated cost saving of $157.2 million.

CONCLUSIONS: Based on the results of AFFIRM-AHF, FCM for the treatment of ID in patients with HFrEF has the potential to reduce HHF burden and deliver cost savings to the healthcare system in the US.