Ferric carboxymaltose for the treatment of iron deficiency in heart failure: a multinational cost-effectiveness analysis utilising AFFIRM-AHF.
Ferric carboxymaltose for the treatment of iron deficiency in heart failure: a multinational cost-effectiveness analysis utilising AFFIRM-AHF.
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DOI：
10.1002/ejhf.2270
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发表时间：
2021-10
影响因子：
18.2
通讯作者：
Jankowska EA
中科院分区：
文献类型：
--
作者：
McEwan P;Ponikowski P;Davis JA;Rosano G;Coats AJS;Dorigotti F;O'Sullivan D;Ramirez de Arellano A;Jankowska EA
铁缺乏在心力衰竭（HF）患者中很常见。在AFFIRM‐AHF中，与安慰剂相比，羧基麦芽糖铁（FCM）降低了近期急性HF发作的缺铁患者因HF（HHF）住院的风险，并改善了生活质量。本研究的目的是使用意大利、英国、美国和瑞士付款人角度的AFFIRM‐AHF试验数据，评估FCM与安慰剂相比在急性HF发作后稳定的左心室射血分数<50%的缺铁患者中的成本效益。根据AFFIRM‐AHF试验，建立了一个终生马尔可夫模型来评估患者的结局。使用12项堪萨斯城心肌病问卷（KCCQ-12）定义健康状态。使用负二项回归模型纳入后续HHF，通过参数生存分析纳入心血管和全因死亡率。直接医疗成本（2020年英镑/美元/欧元/瑞士法郎）和效用值来自已发表文献和AFFIRM‐AHF。模拟结果表明，FCM治疗在英国、美国和瑞士占主导地位（节省成本并获得额外的健康收益），在意大利具有高度的成本效益[增量成本效益比（ICER）为1269欧元/质量调整生命年（QALY）]。结果是由HHF事件的成本降低以及QALY增益0.43-0.44驱动的，这归因于较高KCCQ状态的时间增加（代表更好的功能结局）。敏感性和亚组分析证明了数据的稳健性，ICER在广泛的情况下仍然占主导地位或具有高度成本效益，包括治疗成本增加和各种患者亚组，尽管新发HF的成本适度增加，缺血病因的QALY增加较小。在代表不同医疗保健系统的国家（意大利、英国、美国和瑞士）中，羧基麦芽糖铁估计是一种具有高度成本效益的治疗方法。
Iron deficiency is common in patients with heart failure (HF). In AFFIRM‐AHF, ferric carboxymaltose (FCM) reduced the risk of hospitalisations for HF (HHF) and improved quality of life vs. placebo in iron‐deficient patients with a recent episode of acute HF. The objective of this study was to estimate the cost‐effectiveness of FCM compared with placebo in iron‐deficient patients with left ventricular ejection fraction <50%, stabilised after an episode of acute HF, using data from the AFFIRM‐AHF trial from Italian, UK, US and Swiss payer perspectives. A lifetime Markov model was built to characterise outcomes in patients according to the AFFIRM‐AHF trial. Health states were defined using the 12‐item Kansas City Cardiomyopathy Questionnaire (KCCQ‐12). Subsequent HHF were incorporated using a negative binomial regression model with cardiovascular and all‐cause mortality incorporated via parametric survival analysis. Direct healthcare costs (2020 GBP/USD/EUR/CHF) and utility values were sourced from published literature and AFFIRM‐AHF. Modelled outcomes indicated that treatment with FCM was dominant (cost saving with additional health gains) in the UK, USA and Switzerland, and highly cost‐effective in Italy [incremental cost‐effectiveness ratio (ICER) EUR 1269 per quality‐adjusted life‐year (QALY)]. Results were driven by reduced costs for HHF events combined with QALY gains of 0.43–0.44, attributable to increased time in higher KCCQ states (representing better functional outcomes). Sensitivity and subgroup analyses demonstrated data robustness, with the ICER remaining dominant or highly cost‐effective under a wide range of scenarios, including increasing treatment costs and various patient subgroups, despite a moderate increase in costs for de novo HF and smaller QALY gains for ischaemic aetiology. Ferric carboxymaltose is estimated to be a highly cost‐effective treatment across countries (Italy, UK, USA and Switzerland) representing different healthcare systems.
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影响因子：
18.2
作者：
Groenewegen A;Rutten FH;Mosterd A;Hoes AW
通讯作者：
Hoes AW
DOI：
10.1161/circoutcomes.115.001958
发表时间：
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影响因子：
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通讯作者：
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作者：
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通讯作者：
Jankowska, Ewa A.
影响因子：
9.3
作者：
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通讯作者：
Hauck K