Iron substitution in iron-deficient HF patients is highly cost-effective

A cost-effectiveness analysis using data from the AFFIRM-AHF trial revealed that therapy with ferric carboxymaltose for iron deficiency in heart failure (HF) is highly cost-effective, despite the acquisition costs. This effect was evident across different healthcare systems in the USA, UK, Italy, and Switzerland.

In the AFFIRM-AHF study (NCT02937454), treatment with ferric carboxymaltose (FCM) significantly lowered total HF hospitalisations and cardiovascular death. An analysis presented by Prof. Phil McEwan (Swansea University, UK) estimated the cost-effectiveness of FCM compared with placebo for the treatment of iron deficiency in patients with HF from the payer’s perspective in the USA, UK, Italy and Switzerland [1,2]. “These 4 countries were chosen because they have different systems of healthcare,” Prof. McEwan explained. A lifetime Markov model was built to characterise outcomes in patients according to the AFFIRM-AHF trial. In this model, disease status was defined by quartiles in the Kansas City Cardiomyopathy Questionnaire – clinical summary score (KCCQ-CSS), an established tool to assess symptom frequency, physical limitations, social limitations, and quality of life.

FCM treatment in patients admitted for acute HF was estimated to be cost-saving with additional health gains relative to placebo in the USA, UK, and Switzerland and highly cost-effective in Italy. Cost offsets were largely attributable to a reduction in hospitalisations due to HF. Over a lifetime, FCM was associated with an estimated 199 fewer hospitalisations due to HF events per 1,000 patients.

Modest quality-adjusted life years (QALYs) gains of 0.43–0.44 were attributable to increased time in higher KCCQ states. Moreover, sensitivity analyses demonstrated that FCM was cost-effective (i.e. cost per QALY under the current willingness-to-pay threshold) in all subgroups. The greatest cost savings relative to the overall population were seen in patients with a left ventricular ejection fraction of <25%. Patients with a non-ischaemic HF aetiology achieved the greatest increase in QALYs of all the subgroups. FCM also remained dominant or highly cost-effective in patients receiving triple therapy. De novo HF patients had the greatest cost increase per QALY relative to the overall population due to an increase in life expectancy leading to higher HF maintenance costs. This was dominant in the USA and Switzerland, and cost-effective in the UK and Italy.

Prof. McEwan concluded that from a payer’s perspective, “the relative cost offset by avoiding hospitalisation is sufficiently high to justify the acquisition cost of the drug.”

1. 
   
   1. McEwan P. Ferric carboxymaltose for the treatment of iron deficiency in heart failure: a multinational cost-effectiveness analysis using AFFIRM-AHF. LBT 2, Heart Failure and World Congress on Acute Heart Failure 2021, 29 June–1 July.
   2. McEwan P, et al. Eur J Heart Fail 2021. Doi 10.1002/ejhf.2270.

 

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Posted on 19 August, 202120 August, 2021