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) reported significantly higher incidence of hypophosphatemia after treatment with ferric carboxymaltose (FCM) versus ferric derisomaltose (FDI). The present study objective was to evaluate the cost-utility of FDI versus FCM in patients with IBD in the UK.

METHODS:

A patient-level simulation model was developed in Microsoft Excel 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 the perspective of the Department of Health. 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 0.074 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 GBP 451 per patient (GBP 2,137 versus GBP 1,686). Costs of monitoring and treating hypophosphatemia after treatment with FCM were GBP 308, resulting in total cost savings of GBP 759 per patient (GBP 2,445 versus GBP 1,686) over the five-year time horizon. 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 the UK. The FDI cost savings were driven by reductions in the number of infusions required and the need for monitoring and treatment of hypophosphatemia.