title: Cost of post-operative intravenous iron therapy in total lower limb arthroplasty: a retrospective, matched cohort study.
abstract: BACKGROUND
  Requirements for allogeneic red cell transfusion after total lower limb arthroplasty are still high (20-50%), and post-operative intravenous iron has been shown to reduce transfusion requirements for this surgery. We performed a cost analysis to ascertain whether this alternative is also likely to be cost-effective.
  
  
  METHODS
  Data from 182 matched-pairs of total lower limb arthroplasty patients, managed with a restrictive transfusion protocol and without (control group) or with post-operative intravenous iron (iron group), were retrospectively reviewed. Acquisition and administration costs of iron (iron sucrose or ferric carboxymaltose) and allogeneic red cell concentrates, haemoglobin measurements, and prolonged stay in hospital were used for blood management cost analysis.
  
  
  RESULTS
  Patients in the iron group received 600 mg intravenous iron, without clinically relevant incidents, and had a lower allogeneic transfusion rate (11.5% vs 26.4% for the iron and control groups, respectively; p=0.001). The reduction in transfusion rate was more pronounced in anaemic patients (17% vs 40%; p=0.015) than in non-anaemic ones (9.6% vs 21.2%; p=0.011). There were no differences with respect to post-operative infection rate. Patients receiving allogeneic transfusion stayed in hospital longer (+1.9 days [95% CI: 1.2-2.6]). As intravenous iron reduces the allogeneic transfusion rate, both iron formulations were cost-neutral in the different cost scenarios (-25.5 to 62.1 €/patient for iron sucrose, and -51.1 to 64.4 €/patient for ferric carboxymaltose).
  
  
  CONCLUSIONS
  In patients presenting with or without pre-operative anaemia, post-operative intravenous iron after total lower limb arthroplasty seems to be safe and is associated with reduced transfusion rates, without incremental costs. For anaemic patients, its efficacy could be increased by associating some other blood-saving method.
authors.affiliation: GIEMSA, Torremolinos, Málaga, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Muñoz
authors.affiliation: GIEMSA, Torremolinos, Málaga, Spain.
authors.forename: Susana
authors.initials: S
authors.lastname: Gómez-Ramírez
authors.affiliation: Department of Pharmacology, School of Medicine, University of Málaga, Torremolinos, Málaga, Spain.
authors.forename: Elisa
authors.initials: E
authors.lastname: Martín-Montañez
authors.affiliation: Departments of Orthopaedic Surgery, "Santa Elena" Hospital, Torremolinos, Málaga, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Naveira
authors.affiliation: Postoperative Care Unit, "Santa Elena" Hospital, Torremolinos, Málaga, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Seara
authors.affiliation: Department of Pharmacology, School of Medicine, University of Málaga, Torremolinos, Málaga, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Pavía
mesh_terms: D019643:Arthroplasty, Replacement / Q000191:economics*; D003365:Costs and Cost Analysis; D017707:Erythrocyte Transfusion / Q000191:economics* / Q000379:methods; D005260:Female; D006801:Humans; D007501:Iron / Q000008:administration & dosage* / Q000097:blood; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000191:economics*; D012189:Retrospective Studies
chemical_list: D007501:Iron