OBJECTIVES: Intravenous (IV) iron therapy is the preferred treatment option for patients with inflammatory bowel disease (IBD) and iron deficiency anaemia (IDA). A previous Italian analysis showed ferric derisomaltose (FDI) to improve quality-adjusted life expectancy and reduce costs versus ferric carboxymaltose (FCM), driven by fewer iron administrations and reduced hypophosphataemia risk. Emerging data have shown an elevated incidence of fractures in patients treated with FCM versus FDI. In the present analysis, these data were incorporated into an updated Italian cost-utility analysis of FCM versus FDI in patients with IBD and IDA.

METHODS: A published patient-level simulation model of IV iron treatments in IDA was expanded to incorporate parametric models of fracture-free survival based on recent Austrian data. Fracture-related quality of life (QoL) disutilities were obtained from the literature. Costs of fracture treatment, and iron and phosphate administration were based on Italian diagnosis-related groups. The analysis was conducted over five years from a national payer perspective. An annual discount rate of 3% was applied to future costs and effects.

RESULTS: Over five years, FDI was associated with gains of 0.085 quality-adjusted life years (QALYs) versus FCM from 2.583 QALYs to 2.668 QALYs per patient. Differences in fracture incidence accounted for 10.6% of the overall QALY difference. FDI also led to cost savings of EUR 873 versus FCM, reducing costs from EUR 2,112 to EUR 1,239. Fractures contributed an average of EUR 69 per patient towards FDI-related costs, versus EUR 266 of FCM-related costs. FDI was therefore the dominant intervention and remained dominant in all sensitivity and scenario analyses.

CONCLUSIONS: FDI improved QoL and reduced costs versus FCM for patients living with IDA and IBD in Italy. The inclusion of fractures led to additional QALY gains and further cost savings when compared with a previous Italian analysis, in which FDI was also found to be dominant.