title: Economic appraisal of maintenance parenteral iron administration in treatment of anaemia in chronic haemodialysis patients.
abstract: BACKGROUND
  Iron deficiency is common in haemodialysis patients and adequate supplementation by the oral or parenteral route has been limited by drug side-effects, absorption, and cost. Intermittent doses of intravenous iron dextran complex are recommended in patients with inadequate iron stores despite maximal tolerated oral dose. We conducted a prospective study with economic analysis of a regular maintenance intravenous iron regimen in this group of patients.
  
  
  METHODS
  Fifty patients comprising one-half of our haemodialysis population required intravenous iron treatment, i.e. they failed to achieve an arbitrary goal serum ferritin 100 microg/l despite maximal tolerated oral iron dose. After a loading dose of intravenous iron dextran complex (IV-FeD) based on Van Wyck's nomogram (400+/-300 mg) they received a maintenance dose of 100mg IV-FeD once every 2 weeks. Initial goal serum ferritin was set at 100-200 microg/l. If no increase in haemoglobin was achieved at this level, transferrin saturation was measured to assess bioavailable iron, and when less than 20%, goal serum ferritin was increased to 200-300 microg/l. Recombinant human erythropoietin (rHuEpo) was used where needed to maintain haemoglobin in the 9.5-10.5 g/l range only if ferritin requirements were met. Results. Mean haemoglobin rose from 87.7+/-12.1 to 100.3+/-13.1 g/l (P<0.001, Cl 7.7-17.9) at mean follow-up of 6 months (range 3-15 months). In patients on rHuEpo, dose per patient was reduced from 96+/-59 u/kg per week to 63+/-41 u/kg per week, representing a 35% dose reduction (P<0.05, Cl 1-65). An annual cost reduction of $3166 CDN was projected; however, in the first year this is offset by the cost of the loading dose of IV-FeD required at the beginning of treatment. No adverse reactions were encountered.
  
  
  CONCLUSIONS
  Iron deficiency is very common in our haemodialysis population, especially in those patients receiving rHuEpo. A carefully monitored regimen of maintenance parenteral iron is a safe, effective, and economically favourable means of iron supplementation in patients with insufficient iron stores on maximum tolerated oral supplements.
authors.affiliation: Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: F
authors.initials: F
authors.lastname: Sepandj
authors.forename: K
authors.initials: K
authors.lastname: Jindal
authors.forename: M
authors.initials: M
authors.lastname: West
authors.forename: D
authors.initials: D
authors.lastname: Hirsch
mesh_terms: D000328:Adult; D000368:Aged; D018798:Anemia, Iron-Deficiency / Q000188:drug therapy / Q000191:economics / Q000209:etiology*; D003365:Costs and Cost Analysis; D004921:Erythropoietin / Q000008:administration & dosage; D005260:Female; D006397:Hematinics / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D007505:Iron-Dextran Complex / Q000008:administration & dosage*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000191:economics / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000008:administration & dosage; D006435:Renal Dialysis / Q000009:adverse effects*
chemical_list: D006397:Hematinics; D011994:Recombinant Proteins; D004921:Erythropoietin; D007505:Iron-Dextran Complex