Quality of life related to oral versus subcutaneous iron chelation: a time trade-off study.
OBJECTIVE
To investigate the utility associated with subcutaneous infusion (deferoxamine) compared with once-daily oral administration (deferasirox) of iron chelation therapy.


METHODS
Interviews using the time trade-off technique were used to estimate preferences (utility) for health states by finding the point at which respondents were indifferent between a longer but lower quality of life (QoL) and a shorter time in full health. Participants (n = 110) were community-based, 51% women, median age 35 years, from four regions in Sydney, Australia. Respondents rated three health states involving equal outcomes for people with thalassemia but with different treatment modalities for iron chelation; an "anchor state" describing a patient receiving iron chelation without administration mode specified, anchor state plus iron chelation via subcutaneous infusion, and anchor state plus iron chelation through once-daily oral medication.


RESULTS
On an interval scale between 0 (death) and 1 (full health), median (interquartile range) utility of 0.80 (0.65-0.95) for the anchor state, 0.66 (0.45-0.87) for subcutaneous infusion, and 0.93 (0.80-0.97) for once-daily oral administration was obtained. The mean (median) difference of 0.23 (0.27) between the two treatments was statistically significant (Wilcoxon-signed rank test, P < 0.001). Subcutaneous infusion was associated with a mean (median) utility 0.13 (0.14) lower than the anchor state (P < 0.001), and once-daily oral treatment had a utility 0.10 (0.13) higher (P < 0.001).


CONCLUSIONS
Community respondents associate oral administration of an iron chelator such as deferasirox with enhanced QoL compared with subcutaneous treatment. Assuming equal safety and efficacy, QoL gains from once-daily oral treatment compared with subcutaneous infusion are significant.
Osborne
Richard H
RH
Center for Rheumatic Diseases, Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Vic. 3050, Australia. richardo@unimelb.edu.au
De Abreu Lourenço
Richard
R
Dalton
Andrew
A
Houltram
Jennifer
J
Dowton
David
D
Joshua
Douglas Edgar
DE
Lindeman
Robert
R
Ho
Phoebe Joy
PJ
D000284:Administration, Oral; D000328:Adult; D015913:Chelation Therapy / Q000379:methods*; D003676:Deferoxamine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007260:Infusion Pumps; D007263:Infusions, Parenteral; D019190:Iron Overload / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D017060:Patient Satisfaction; D011788:Quality of Life; D017262:Siderophores / Q000008:administration & dosage*; D013997:Time Factors
D017262:Siderophores; D003676:Deferoxamine