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, 15 (5), 438-446

A Fast-Track Anaemia Clinic in the Emergency Department: Cost-Analysis of Intravenous Iron Administration for Treating Iron-Deficiency Anaemia

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A Fast-Track Anaemia Clinic in the Emergency Department: Cost-Analysis of Intravenous Iron Administration for Treating Iron-Deficiency Anaemia

Manuel Quintana-Díaz et al. Blood Transfus.

Abstract

Background: A fast-track anaemia clinic (FTAC) for the management of moderate-to-severe iron-deficiency anaemia (IDA) was established in our Emergency Department in 2010. In this FTAC, the replacement of packed red cell transfusion by ferric carboxymaltose administration was proven to be safe and effective. The aim of this study was a cost-analysis of IDA management in the FTAC, comparing this management with the previous standard care pathway consisting of packed red cell transfusion, if needed, and referral to outpatient specialised care.

Materials and methods: A cost study was performed for patients with IDA who were at risk of requiring transfusion (haemoglobin <9 g/dL) but did not require hospitalisation. Total IDA treatment costs in the FTAC were compared to those theoretically incurred if these patients had been managed using the standard care pathway. In addition, a sensitivity analysis considering variations of up to ±30% in ferric carboxymaltose and packed red cell acquisition costs was performed (49 possible scenarios).

Results: Between 2012 and 2015, 238 IDA patients were treated in the FTAC. The average treatment cost was € 594±337/patient in the FTAC group and € 672±301/patient in the standard care pathway group, with a saving of € 78±28/patient (95% CI, 22-133; p<0.001). The sensitivity analysis showed that IDA treatment costs in the FTAC (€ 480-722/patient), compared with those of the standard care pathway (€ 550-794/patient), resulted in significant cost-savings for all studied scenarios (€ 51-104/patient; p<0.005).

Discussion: The administration of ferric carboxymaltose for IDA management in a FTAC may be cost-saving compared with the standard care pathway.

Conflict of interest statement

Disclosure of conflict of interest

MQD has received honoraria for consultancy or lectures and/or travel support from Octapharma (Spain & Switzerland) and Vifor Pharma (Spain) but not for this work. JAGE has received honoraria for consultancy or lectures and/or travel support from Wellspect HealthCare (Sweden), Roche (Spain), Vifor Pharma (Spain & Switzerland), Amgen (Spain), Janssen-Cilag (Spain) and Novartis (Spain) but not for this work. MM has received honoraria for consultancy or lectures and/or travel support from Wellspect HealthCare (Sweden), Roche (Spain), Vifor Pharma (Spain & Switzerland), PharmaCosmos (Denmark) and Zambon (Spain) but not for this work. AMB, JP, RMR and SGR have nothing to declare.

Figures

Figure 1
Figure 1
Study design and patients’ disposition. ED: Emergency Department, Hb: haemoglobin, IDA: iron-deficiency anaemia, IV: intravenous, PRC: packed red cells.
Figure 2
Figure 2
Sensitivity analysis of management costs for moderate-to-severe iron deficiency anaemia in the Fast-Track Anaemia Clinic in the Emergency Department (FTAC group, A) or with standard outpatient specialised care (SCP group, B), and differences between them (Cost saving, C), considering variations of up to 30% in the acquisition costs (euros) of ferric carboxymaltose (FCM) and packed red cell (PRC) units. Cost savings were significant in all 49 analysed scenarios (p<0.01).

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