OBJECTIVES: The prevalence of inflammatory bowel disease (IBD) in the Netherlands was 432 per 100,000 in 2010 and rising. Iron deficiency anaemia (IDA) is common in patients with IBD, secondary to chronic blood loss and impaired iron absorption, and intravenous iron is recommended in patients with active disease. The objective was to conduct a cost-utility analysis of two high-dose intravenous iron formulations — ferric derisomaltose (FDI) and ferric carboxymaltose (FCM) — in patients with IBD and IDA in the Netherlands, capturing differences in iron dosing, phosphate monitoring, and post-infusion incidence of hypophosphataemia and fractures.

METHODS: A previously-published, patient-level, cost-utility model of IDA was extended to incorporate parametric survival models of fracture-free survival based on data from patients who received FDI (n=110) and FCM (n=179). Quality of life was modeled based on the PHOSPHARE-IBD randomized controlled trial, a published diminishing marginal utility model, and fracture-related disutilities from the literature. Costs were obtained primarily from the Dutch DBC system (hospital case-based payment system). The analysis was conducted over five years from a health insurer perspective and future costs and effects were discounted at 3% and 1.5% annually, respectively. Deterministic and probabilistic sensitivity analyses were performed.

RESULTS: Over five years, patients experienced an average of 2.72 quality-adjusted life years (QALYs) with FDI versus 2.63 QALYs with FCM, corresponding to an incremental gain of 0.09 QALYs with FDI. Of the 0.09 QALY difference, 81.4% was driven by differences in fatigue and hypophosphataemia, 9.4% by differences in iron infusion-related disutilities, and 9.3% by differences in fracture incidence. Total costs in the FDI arm were EUR 2,887 lower than those in the FCM arm (EUR 7,624 versus EUR 10,511). FDI was the dominant intervention.

CONCLUSIONS: Relative to FCM, FDI was associated with greater QoL and lower costs from the insurer-perspective in patients living with IDA and IBD in the Netherlands.