title: Cost-effectiveness analysis of ferric carboxymaltose in iron-deficient patients with chronic heart failure in Sweden.
abstract: OBJECTIVE
  Iron deficiency is a common but treatable comorbidity in chronic heart failure (CHF) that is associated with impaired health-related quality-of-life (HRQoL). This study evaluates the cost-effectiveness of the intravenous iron preparation ferric carboxymaltose (FCM) for the treatment of iron deficiency in CHF from a Swedish healthcare perspective.
  
  
  METHODS
  A cost-effectiveness analysis with a time horizon of 24 weeks was performed to compare FCM treatment with placebo. Data on health outcomes and medical resource use were mainly taken from the FAIR-HF trial and combined with Swedish cost data. An incremental cost-effectiveness ratio (ICER) was calculated as well as the change in per-patient costs for primary care and hospital care.
  
  
  RESULTS
  In the FCM group compared with placebo, quality-adjusted life years (QALYs) are higher (difference = 0.037 QALYs), but so are per-patient costs [(difference = SEK 2789 (€303)]. Primary care and hospital care equally share the additional costs, but within hospitals there is a major shift of costs from inpatient care to outpatient care. The ICER is SEK 75,389 (€8194) per QALY. The robustness of the result is supported by sensitivity analyses.
  
  
  CONCLUSIONS
  Treatment of iron deficiency in CHF with FCM compared with placebo is estimated to be cost-effective. The ICER in the base case scenario is twice as high as previously thought, but noticeably below SEK 500,000 (€54,300) per QALY, an informal average reference value used by the Swedish Dental and Pharmaceutical Benefits Agency. Increased HRQoL and fewer hospitalizations are the key drivers of this result.
authors.affiliation: Department of Economics, Lund University, Lund, Sweden, and IHE - The Swedish Institute for Health Economics , Lund , Sweden.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hofmarcher
authors.forename: Sixten
authors.initials: S
authors.lastname: Borg
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D005260:Female; D005290:Ferric Compounds / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D007297:Inpatients; D000090463:Iron Deficiencies; D008297:Male; D008320:Maltose / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D008875:Middle Aged; D017059:Models, Econometric; D010045:Outpatients; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D013548:Sweden
chemical_list: D005290:Ferric Compounds; C522335:ferric carboxymaltose; D008320:Maltose
keywords: Chronic heart failure; Cost-effectiveness analysis; Ferric carboxymaltose; Healthcare costs; Iron deficiency