OBJECTIVES: Iron deficiency/anaemia (ID/A) has been reported as a frequent comorbidity in non-dialysis chronic kidney disease (ND CKD) and is associated with reduced functional capacity, poor quality of life, and increased mortality. Study aims were to compare health-related outcomes and healthcare costs of ND CKD patients with ID/A and specific iron treatment in Germany.

METHODS: A retrospective, matched cohort analysis was conducted. German claims data from the InGef research database containing over 4 million covered lives were used. ND CKD patients stages 3 and 4 with ID/A were identified by ICD-10-GM codes in 2014 with individual pre- and post-index periods of 4 quarters. Incident iron treatment defined the index quarter and was stratified by oral, low dose (<1000mg) and high dose (≥1000mg) intravenous iron based on Anatomical Therapeutic Chemical Classification codes and Pharmacy Central Numbers. A 1:1:1 propensity score matching was performed including the parameters age, gender, Charlson Comorbidity Index, and baseline costs to assess health-related outcomes.

RESULTS: In total, n=1,840 ND CKD patients received oral iron, n=150 low dose intravenous, and n=41 high dose intravenous iron with over 90% being treated with Ferric Carboxymaltose. After matching, 37 patients remained in each treatment cohort. Differences were observed concerning all-cause hospitalizations (oral iron vs. high dose intravenous iron (89.2% vs. 78.4%, p=0.227)) and ID/A-related hospitalizations (oral iron vs. low dose intravenous iron (51.4% vs. 24.3%, p=0.027) and oral iron vs. high dose intravenous iron (51.4% vs. 29.7%, p=0.049)). The cost comparison revealed significantly higher average ID/A-related hospitalization costs for the oral iron cohort and lowest costs for the high intravenous iron cohort. The oral iron cohort had the highest observable mortality.

CONCLUSIONS: The results showed that the use of high dose intravenous iron treatment was associated with the lowest all-cause hospitalization and the highest cost savings, compared to oral and low dose intravenous iron.