Abstract
Aims: To assess the impact of different intravenous (IV) irons on healthcare resource utilization (HCRU), cost of care (CoC), and post-treatment iron deficiency/iron deficiency anemia (ID/IDA) in elderly patients with heart failure (HF) and ID/IDA.
Methods: This retrospective cohort study used a US healthcare claims database. Eligible patients were ≥ 65 years old with ≥ 1 medical claim for HF and ID/IDA. Patients were indexed on their first IV iron claim and had ≥ 12 months continuous enrollment before and after the index date. Inverse probability of treatment weighting (IPTW) was used to compare HF-related HCRU, CoC, and ID/IDA rates in the 12 months post-index in patients receiving different IV iron products.
Results: After IPTW, 6,471 patients were included with a mean age of approximately 82 years. Nearly 60% of patients were female and around 80% of patients were white. The mean CCI scores ranged from 3.70 to 3.84 across different IV iron cohorts. Above 90% of patients had hypertension, which was the most prevalent comorbidity. Patients receiving ferric carboxymaltose (FCM) had fewer HF-related medical visits than patients receiving sodium ferric gluconate complex in sucrose (FG) (ratio=0.74, P=0.03), ferumoxytol (FM) (ratio=0.97, P=0.75) and iron sucrose (IS) (ratio=0.87, P=0.11). Patients taking FCM had the shortest HF-related hospital inpatient stay (vs. FG ratio=0.20, P=0.02; vs. low-molecular-weight iron dextran [LMWID] ratio=0.27, P=0.04; vs. IS ratio=0.32, P=0.01; vs. FM ratio=0.40, P=0.08) and lowest HF-related CoC (vs. FG ratio=0.48, P<0.0001; vs. LMWID ratio=0.67, P<0.0001; vs. IS ratio=0.69, P<0.0001; vs. FM ratio=0.93, P=0.32). FCM recipients were least likely to have ID/IDA versus patients taking other IV irons in the follow-up period.
Limitations: Findings may not be generalizable to non-Medicare patients or those with HF as a secondary or other diagnosis. Patients with ID/IDA may not be fully captured due to lack of transferrin values.
Conclusions: Patients receiving FCM had the shortest HF-related hospital inpatient stay, lowest HF-related medical CoC, and lowest proportions of ID/IDA in the follow-up period compared to other IV irons. FCM may confer potential benefits in reducing HCRU and CoC that decreases the economic burden of ID/IDA on HF patients and healthcare plans.
Keywords
Cost of care, Ferric carboxymaltose, Healthcare resource utilization, Health outcomes, Heart failure, Intravenous iron, Iron deficiency, Iron deficiency anemia