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      Budget impact of intravenous ferric carboxymaltose in patients with chronic heart failure and iron deficiency in France

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          Abstract

          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 €0.8m savings. The cumulative savings resulted from a reduction in the hospitalization costs associated with worsening heart failure (€−35.8m) as well as a reduction in the follow‐up costs (€−2.9m). These cost savings outweighed the costs of ferric carboxymaltose treatment (€37.7m). Sensitivity analyses showed that the budget impact varied from €−34m to €+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.

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          Most cited references12

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          Effects of ferric carboxymaltose on hospitalisations and mortality rates in iron-deficient heart failure patients: an individual patient data meta-analysis

          Iron deficiency (ID) is a common co-morbidity in patients with heart failure (HF) and has been suggested to be associated with poor prognosis. Recently completed double-blind randomised controlled trials (RCTs) studying HF patients with ID have shown improvements in functional capacity, symptoms and quality of life when treated with i.v. ferric carboxymaltose (FCM). This individual patient data meta-analysis investigates the effect of FCM vs. placebo on recurrent hospitalisations and mortality in HF patients with ID.
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            High prevalence of iron deficiency in patients with acute decompensated heart failure.

            Limited data are available on iron parameters in patients hospitalized for decompensation of chronic heart failure.
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              Iron deficiency: an emerging therapeutic target in heart failure.

              In patients with heart failure, iron deficiency is frequent but overlooked, with a prevalence of 30%-50%. Since it contributes to cardiac and peripheral muscle dysfunction, iron deficiency is associated with poorer clinical outcomes and a greater risk of death, independent of haemoglobin level. Therefore, iron deficiency emerges as a new comorbidity and a therapeutic target of chronic heart failure in addition to chronic renal insufficiency, anaemia and diabetes. In a series of placebo-controlled, randomised studies in patients with heart failure and iron deficiency, intravenous iron had a favourable effect on exercise capacity, functional class, LVEF, renal function and quality of life. These clinical studies were performed in the context of a renewed interest in iron metabolism. During the past 10 years, knowledge about the transport, storage and homeostasis of iron has improved dramatically, and new molecules involved in iron metabolism have been described (eg, hepcidin, ferroportin, divalent metal transporter 1). Recent European guidelines recommend the monitoring of iron parameters (ie, serum ferritin, transferrin saturation) for all patients with heart failure. Ongoing clinical trials will explore the benefits of iron deficiency correction on various heart failure parameters.
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                Author and article information

                Contributors
                mathilde.faller@iqvia.com
                Journal
                ESC Heart Fail
                ESC Heart Fail
                10.1002/(ISSN)2055-5822
                EHF2
                ESC Heart Failure
                John Wiley and Sons Inc. (Hoboken )
                2055-5822
                25 April 2019
                June 2019
                : 6
                : 3 ( doiID: 10.1002/ehf2.v6.3 )
                : 559-569
                Affiliations
                [ 1 ] IQVIA Courbevoie France
                [ 2 ] Vifor Pharma France Paris France
                [ 3 ] Hox‐Com Analytiques Vincennes France
                [ 4 ] INSERM UMRS‐942, Sorbonne Paris Cite, Lariboisière Hospital—AP‐HP Paris France
                Author notes
                [*] [* ] Correspondence to: Mathilde Faller, IQVIA, Courbevoie, France. Email: mathilde.faller@ 123456iqvia.com

                Article
                EHF212432 ESCHF-18-00174
                10.1002/ehf2.12432
                6487717
                31021531
                1d7b672c-3296-4667-8bf4-41a678a992ee
                © 2019 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 27 August 2018
                : 15 February 2019
                Page count
                Figures: 1, Tables: 11, Pages: 11, Words: 4471
                Funding
                Funded by: Vifor Pharma Ltd.
                Categories
                Original Research Article
                Original Research Articles
                Custom metadata
                2.0
                ehf212432
                June 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.2.1 mode:remove_FC converted:29.04.2019

                iron deficiency,chronic heart failure,cost,budget impact,ferric carboxymaltose

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