Budget impact of intravenous ferric carboxymaltose in patients with chronic heart failure and iron deficiency in France
Budget impact of intravenous ferric carboxymaltose in patients with chronic heart failure and iron deficiency in France
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DOI：
10.1002/ehf2.12432
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发表时间：
2019-06-01
影响因子：
3.8
通讯作者：
Cohen-Solal, Alain
中科院分区：
文献类型：
--
作者：
Bourguignon, Sandrine;Faller, Mathilde;Cohen-Solal, Alain
目的本分析的目的是评估预算的影响，静脉铁剂治疗与羧基麦芽糖铁收缩性慢性心力衰竭和铁缺乏症的患者，从法国公共医疗保险的角度。方法和结果的预算影响模型进行了调整，以预测预算的影响超过5年，根据两种情况：一种情况下，患者接受羧基麦芽糖铁根据市场份额预测，另一种情况下，患者不接受治疗缺铁。临床数据是从四项随机对照试验的汇总数据中推断出来的。通过应用CONFIRM-HF试验估计的转移概率，将时间范围延长至5年。法国的流行病学参数来自文献。费用参数来自国家现有数据库。在基础病例分析中，在189334例流行和偶发患者中，使用羧基麦芽糖铁与不使用缺铁治疗的情景之间的建模5年成本差异导致节省80万欧元。累计节省的原因是与心力衰竭恶化相关的住院费用减少（3 580万欧元）以及后续费用减少（290万欧元）。这些节省的费用超过了羧基麦芽糖铁处理的费用（3 770万欧元）。敏感性分析表明，预算影响从-3，400万欧元到+1.46亿欧元不等。对预算影响最大的参数是未接受缺铁治疗的患者的住院率、所需的门诊次数、纽约心脏协会类别之间没有住院费用差异以及管理设置费用。结论羧基麦芽糖铁治疗收缩期慢性心力衰竭患者缺铁可改善纽约心脏协会分级，从而提高患者的健康水平，同时为法国国民健康保险节省总费用。
Aims This analysis aims to evaluate the budget impact of intravenous iron therapy with ferric carboxymaltose for patients with systolic chronic heart failure and iron deficiency, from the perspective of the French public health insurance. Methods and results A budget impact model was adapted to forecast the budget impact over 5 years, according to two scenarios: one where patients receive ferric carboxymaltose according to market share forecast and another where patients are not treated for iron deficiency. Clinical data were extrapolated from pooled data from four randomized controlled trials. The time horizon was extended to 5 years by applying transition probabilities estimated from the CONFIRM-HF trial. Epidemiological parameters for France were derived from the literature. Cost parameters were derived from national available databases. In the base case analysis, the modelled 5 year cost difference between the scenarios with ferric carboxymaltose vs. no iron deficiency treatment in a population of 189 334 prevalent and incident patients led to euro0.8m savings. The cumulative savings resulted from a reduction in the hospitalization costs associated with worsening heart failure (euro-35.8m) as well as a reduction in the follow-up costs (euro-2.9m). These cost savings outweighed the costs of ferric carboxymaltose treatment (euro37.7m). Sensitivity analyses showed that the budget impact varied from euro-34m to euro+146m. Parameters with the most impact on the budget were the hospitalization rate for patients not treated for iron deficiency, the number of ambulatory sessions needed, the absence of hospitalization cost differentiation between New York Heart Association classes, and administration settings costs. Conclusions Iron deficiency treatment with ferric carboxymaltose in systolic chronic heart failure patients results in an improvement of New York Heart Association class and thereby increases the well-being of the patients, while providing an overall cost saving for the French national health insurance.