title: [Iron substitution in outpatients in Switzerland: Increase of costs associated with intravenous administration].
abstract: Iron anaemia and iron-deficient erythropoiesis are treated with oral iron supplements. For chronic haemodialysis or in the case of therapy failure or intolerance to oral iron therapy, intravenous supplements are administered. The costs of iron supplements borne by statutory health care insurance had strongly increased during the observation period from 2006 to 2010. Based on the invoice data of a large health insurance company with a market share of around 18 %, prescription data of iron preparations and laboratory tests were analysed and extrapolated to the Swiss population. During the 5-year observation period, costs of intravenous iron substitution increased by 16.5 m EUR (340.3 %) and the number of individuals treated by 243.5 %. A sharp rise was observed in women of menstruating age, which was mainly due to prescriptions issued by primary care physicians. More than 8 % of intravenous iron substitutions were administered without prior laboratory analysis,and must therefore be regarded as off-label use. A cost-benefit analysis is needed to demonstrate the additional value of intravenous over oral iron supplementation, and intravenous iron supplementation should be administered only to patients with proven iron deficiency.
authors.affiliation: Institut für Pflegewissenschaften, Universität Basel. max.giger@unibas.ch
authors.forename: Max
authors.initials: M
authors.lastname: Giger
authors.forename: Rita
authors.initials: R
authors.lastname: Achermann
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics*; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D017046:Cost Savings / Q000191:economics*; D003430:Cross-Sectional Studies; D016527:Drug Costs / Q000706:statistics & numerical data*; D005260:Female; D005290:Ferric Compounds / Q000008:administration & dosage / Q000191:economics; D000077605:Ferric Oxide, Saccharated; D005293:Ferritins / Q000097:blood; D005937:Glucaric Acid / Q000008:administration & dosage / Q000191:economics; D006452:Hemoglobinometry; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous / Q000191:economics; D058085:Iron Compounds / Q000008:administration & dosage* / Q000191:economics; D008297:Male; D008320:Maltose / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics*; D056687:Off-Label Use / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013557:Switzerland; D055815:Young Adult
chemical_list: D005290:Ferric Compounds; D058085:Iron Compounds; C522335:ferric carboxymaltose; D008320:Maltose; D005293:Ferritins; D000077605:Ferric Oxide, Saccharated; D005937:Glucaric Acid
keywords: Intravenöse Eisen-Substitution; Iron substitution; Kostenentwicklung, Kostenanalyse; Medizinischer und ökonomischer Mehrwert; Off-Label Use; clinical and economic value; cost analysis; cost trend; indication; off-label use