OBJECTIVES: Iron deficiency (ID) and iron deficiency anemia (IDA) are common comorbidities associated with inflammatory bowel disease (IBD). They can have a significant impact on quality of life and healthcare cost. Intravenous iron has shown clinical benefit for IBD patients compared to oral iron therapy. This study aimed to compare healthcare outcomes and cost after oral vs. intravenous iron treatment for IBD patients with ID/A. METHODS:

The Health Risk Institute research claims database was used to identify IBD patients with ID/A by ICD-10-GM codes and type of iron treatment via ATC codes in 2013. An individual pre-observation period was required to identify newly iron treated patients. Propensity score matching was performed to directly balance both treatment groups regarding age, gender, and comorbidities. Non-observable covariates were adjusted by applying the difference-in-differences (DID) approach. RESULTS: In 2013, 589 IBD patients with ID/A began oral and 442 intravenous iron treatment. Age, gender and comorbidities matched patients were identified for 380 patients in each treatment group. Mean age was adjusted for oral and intravenous iron patients (42.3 vs. 42.2 years) and 67% vs. 61% were female, respectively. The intravenous group had fewer all-cause hospitalizations (37% vs. 48%) as well as IBD-related hospitalizations (5% vs. 14%) than the oral iron group. The one-year pre-observation period comparison revealed significant expenditure differences between both groups. After adjusting for expenditure differences by DID, total healthcare cost savings in the intravenous iron group of 367€ were calculated. While higher expenditures occurred in the intravenous iron group for medication (1,876€ vs. oral), the inpatient setting achieved most cost savings (1,887€ vs. oral). CONCLUSIONS:

Our data demonstrates that IBD patients receiving intravenous iron incurred less hospitalizations and lower total healthcare costs compared to oral iron patients. Higher expenditures for pharmaceuticals (comprising a minor share for iron treatment) were compensated by cost savings in other domains.