title: An analysis of the health service efficiency and patient experience with two different intravenous iron preparations in a UK anaemia clinic.
abstract: BACKGROUND
  Historically, the Renal Unit at King's College Hospital used intravenous (IV) iron sucrose (IS) to treat iron deficiency anaemia in patients with chronic kidney disease who were not on dialysis (CKD-ND). As part of a service initiative to improve patient experience, new products were considered as alternatives. This study investigated the potential impact on patient experience and service costs by switching from IS to ferric carboxymaltose (FCM).
  
  
  METHODS
  A decision analytical model was used to calculate the impact of switching from IS to FCM for a cohort of CKD-ND patients. Service provision data were collected for 365 patients who received 600 mg IS within a 12 month period, creating the IS data set. The service provision data, along with a clinically relevant FCM administration protocol (stipulating total doses of 500 mg FCM), were used to calculate a corresponding theoretical data set for FCM for the same cohort of patients.
  
  
  RESULTS
  The FCM protocol saved each patient two hospital visits and 2.66 hours of time (equating to approximately a saving of £36.21 in loss of earnings) and £19 in travel costs. Direct attributable costs for iron administration (which included drug, disposables, nursing staff, and hospital-provided patient transport costs) were £58,646 for IS vs £46,473 for FCM. Direct overhead costs (which included nursing preparation time, administration staff, clinic space, and consultant time costs) were £40,172 for the IS service vs £15,174 for the FCM service.
  
  
  CONCLUSIONS
  Based on clinical experience with the products, this analysis assumes that 500 mg FCM is therapeutically equivalent to 600 mg IS. Consultant time costs are assumed to be the same between the two treatment groups. IV iron administration protocols and data are specific to King's College Hospital. The design is retrospective and changes to the management of the clinic, including service delivery optimization, may also affect real costs.
  
  
  CONCLUSIONS
  FCM was associated with fewer hospital visits and reduced transport costs for CKD-ND patients receiving IV iron and has the potential to save 19-37% in service costs. Owing to increased administration efficiency, FCM can improve the overall patient experience while reducing the total cost of the King's College Hospital IV iron service for CKD-ND patients, compared with treatment with IS.
authors.affiliation: Department of Renal Medicine, King's College Hospital, London, UK. p.wilson1@nhs.net
authors.forename: Paul D
authors.initials: PD
authors.lastname: Wilson
authors.forename: Adam
authors.initials: A
authors.lastname: Hutchings
authors.forename: Aruna
authors.initials: A
authors.lastname: Jeans
authors.forename: Iain C
authors.initials: IC
authors.lastname: Macdougall
mesh_terms: D061605:Administration, Intravenous; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D018798:Anemia, Iron-Deficiency / Q000188:drug therapy* / Q000209:etiology; D002985:Clinical Protocols; D003365:Costs and Cost Analysis; D003661:Decision Support Techniques; D017598:Efficiency, Organizational; D005290:Ferric Compounds / Q000191:economics* / Q000627:therapeutic use; D000077605:Ferric Oxide, Saccharated; D005937:Glucaric Acid / Q000191:economics* / Q000627:therapeutic use; D006397:Hematinics / Q000191:economics* / Q000627:therapeutic use; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008320:Maltose / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D057240:Patient Preference; D051436:Renal Insufficiency, Chronic / Q000150:complications; D014186:Transportation / Q000191:economics; D006113:United Kingdom
chemical_list: D005290:Ferric Compounds; D006397:Hematinics; C522335:ferric carboxymaltose; D008320:Maltose; D000077605:Ferric Oxide, Saccharated; D005937:Glucaric Acid