OBJECTIVES: Iron deficiency anemia (IDA) is the most common extraintestinal manifestation of inflammatory bowel disease (IBD), driven by impaired iron absorption and inflammation of the intestinal mucosa. Exogenous iron is indicated to correct the iron deficiency, with intravenous iron preferred in patients with malabsorption or intolerance of oral iron, active bleeding, or active inflammation. The objective was to assess the cost-utility of two high-dose, rapid-infusion irons — ferric derisomaltose (FDI) and ferric carboxymaltose (FCM) — in the treatment of patients with IBD and IDA in Sweden.

METHODS: The cost-utility of FDI versus FCM in patients with IBD and IDA was evaluated using a previously-published patient-level simulation model. Iron need was modeled based on the product labeling and patient characteristics from the PHOSPHARE-IBD randomized controlled trial. Disease-related quality of life (QoL) and post-infusion hypophosphatemia incidence were also modeled in line with PHOSPHARE-IBD. Cost-utility was evaluated from the national healthcare payer perspective over a five-year time horizon.

RESULTS: For each course of iron treatment, patients treated with FDI required 0.38 fewer infusions than those treated with FCM. The reduced number of infusions resulted in cost savings of SEK 6,424 per patient over five years (SEK 30,426 with FCM versus SEK 24,002 with FDI). Phosphate monitoring in patients treated with FCM cost SEK 1,543 over five years versus no monitoring costs with FDI. Total cost savings with FDI were therefore SEK 7,967. FDI also resulted in a 0.075 quality-adjusted life year improvement versus FCM, driven primarily by the QoL improvements reported in PHOSPHARE-IBD.

CONCLUSIONS: Relative to FCM, FDI was associated with cost savings arising from the need for fewer infusions and the obviation of the need for phosphate monitoring. FDI also improved QoL and would therefore represent the more efficient use of healthcare budget and resource for iron replenishment in patients with IBD and IDA in Sweden.