title: Erythrocytapheresis versus phlebotomy in the initial treatment of HFE hemochromatosis patients: results from a randomized trial.
abstract: BACKGROUND
  Standard treatment of newly diagnosed HFE hemochromatosis patients is phlebotomy. Erythrocytapheresis provides a new therapeutic modality that can remove up to three times more red blood cells per single procedure and could thus have a clinical and economic benefit.
  
  
  METHODS
  To compare the number of treatment procedures between erythrocytapheresis and phlebotomy needed to reach the serum ferritin (SF) target level of 50 µg/L, a two-treatment-arms, randomized trial was conducted in which 38 newly diagnosed patients homozygous for C282Y were randomly assigned in a 1:1 ratio to undergo either erythrocytapheresis or phlebotomy. A 50% decrease in the number of treatment procedures for erythrocytapheresis compared to phlebotomy was chosen as the relevant difference to detect.
  
  
  RESULTS
  Univariate analysis showed a significantly lower mean number of treatment procedures in the erythrocytapheresis group (9 vs. 27; ratio, 0.33; 95% confidence interval [CI], 0.25-0.45; Mann-Whitney p < 0.001). After adjustments for the two important influential factors initial SF level and body weight, the reduction ratio was still significant (0.43; 95% CI, 0.35-0.52; p < 0.001). Cost analysis showed no significant difference in treatment costs between both procedures. The costs resulting from productivity loss were significantly lower for the erythrocytapheresis group.
  
  
  CONCLUSIONS
  Erythrocytapheresis is highly effective treatment to reduce iron overload and from a societal perspective might potentially also be a cost-saving therapy.
authors.affiliation: Department of Clinical Consultancy Services, Sanquin Blood Supply, Maastricht, the Netherlands. e.rombout@sanquin.nl
authors.forename: Eva
authors.initials: E
authors.lastname: Rombout-Sestrienkova
authors.forename: Fred H M
authors.initials: FH
authors.lastname: Nieman
authors.forename: Brigitte A B
authors.initials: BA
authors.lastname: Essers
authors.forename: Paulus A H
authors.initials: PA
authors.lastname: van Noord
authors.forename: Mirian C H
authors.initials: MC
authors.lastname: Janssen
authors.forename: Cees Th B M
authors.initials: CT
authors.lastname: van Deursen
authors.forename: Laurens P
authors.initials: LP
authors.lastname: Bos
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Rombout
authors.forename: Rogier
authors.initials: R
authors.lastname: van den Braak
authors.forename: Peter W
authors.initials: PW
authors.lastname: de Leeuw
authors.forename: Ger H
authors.initials: GH
authors.lastname: Koek
mesh_terms: D000328:Adult; D001781:Blood Component Removal / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D004912:Erythrocytes; D005260:Female; D017048:Health Care Costs; D006432:Hemochromatosis / Q000097:blood / Q000235:genetics / Q000628:therapy*; D000071020:Hemochromatosis Protein; D015395:Histocompatibility Antigens Class I / Q000235:genetics; D006720:Homozygote; D006801:Humans; D019190:Iron Overload / Q000235:genetics / Q000628:therapy; D008297:Male; D008565:Membrane Proteins / Q000235:genetics; D008875:Middle Aged; D008955:Models, Cardiovascular; D018962:Phlebotomy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome
chemical_list: C103673:HFE protein, human; D000071020:Hemochromatosis Protein; D015395:Histocompatibility Antigens Class I; D008565:Membrane Proteins