OBJECTIVES:

Anemia is the most common systemic complication and extra-intestinal manifestation of IBD. A meta-analysis has published an overall prevalence rate in IBD patients of 24% (95%CI, 18–31). As anemia is a serious medical condition that may become life threatening, preventive measures should be considered. Two pivotal studies (FERGIcor and FERGImain) showed clinical meaningful results of FCM regarding to Hb increase 2 g/dL and prolonged time to recurrence of anemia. The purpose of this study was to evaluate the cost-effectiveness of FCM versus Iron-Sucrose (IS) and no-treatment in IBD patients with iron deficiency anemia (IDA).

METHODS:

We developed a Markov-Model to simulate the treatment pathway of IDA in IBD patients. Patients with mild/moderate IBD and IDA run into the model and receive different strategies of iron-deficiency-management (FCM, IS or no-treatment). The model includes 6 states (treatment success, recurrent anemia, hospitalization, disease worsening and death) based on RCT-data of FERGIcor and FERGImain. The cohort definition was adapted from the FERGIcor study. Monte Carlo simulation accounted for uncertainty. Direct costs were retrieved from published sources for 2016 and were expressed in Euro from the payer’s perspective. QALYs and total costs were projected over a 5-year time-horizon and discounted at 5% p.a.

RESULTS:

Over a 5-year timeframe, costs and outcomes associated with FCM would amount to 3,630€ and 3.22 QALYs. Costs associated with IS are 3,144€ and 3.18 QALYs (incremental-cost-utility-ratios ICUR: 11,780€). Costs and outcomes associated with no-treatment are 3,227€ and 2.97 QALYs (ICUR: 1,585€). At the study endpoint 22.95% of patients are anemic in the FCM-group, 32.23% in the IS-group and 99.86% in the group without treatment.

CONCLUSIONS:

IDA treatment with FCM compared with IS or no-treatment is clearly below the CE threshold of €22,200-€33,300/QALY typically used by the UK NICE and hence can be considered as a cost-effective treatment strategy.