A fast-track anaemia clinic in the Emergency Department: cost-analysis of intravenous iron administration for treating iron-deficiency anaemia.
BACKGROUND
A fast-track anaemia clinic (FTAC) for the management of moderate-to-severe iron-deficiency anaemia (IDA) was established in our Emergency Department in 2010. In this FTAC, the replacement of packed red cell transfusion by ferric carboxymaltose administration was proven to be safe and effective. The aim of this study was a cost-analysis of IDA management in the FTAC, comparing this management with the previous standard care pathway consisting of packed red cell transfusion, if needed, and referral to outpatient specialised care.


METHODS
A cost study was performed for patients with IDA who were at risk of requiring transfusion (haemoglobin <9 g/dL) but did not require hospitalisation. Total IDA treatment costs in the FTAC were compared to those theoretically incurred if these patients had been managed using the standard care pathway. In addition, a sensitivity analysis considering variations of up to ±30% in ferric carboxymaltose and packed red cell acquisition costs was performed (49 possible scenarios).


RESULTS
Between 2012 and 2015, 238 IDA patients were treated in the FTAC. The average treatment cost was € 594±337/patient in the FTAC group and € 672±301/patient in the standard care pathway group, with a saving of € 78±28/patient (95% CI, 22-133; p<0.001). The sensitivity analysis showed that IDA treatment costs in the FTAC (€ 480-722/patient), compared with those of the standard care pathway (€ 550-794/patient), resulted in significant cost-savings for all studied scenarios (€ 51-104/patient; p<0.005).


CONCLUSIONS
The administration of ferric carboxymaltose for IDA management in a FTAC may be cost-saving compared with the standard care pathway.
Intensive Care Unit, University Hospital La Paz, Madrid, Spain.|Research Institute, University Hospital La Paz (IdiPAZ), Madrid, Spain.
Manuel
M
Quintana-Díaz
Clinical Pharmacology, School of Medicine, Autonomous University of Madrid, Madrid, Spain.
Raúl
R
Muñoz-Romo
Internal Medicine, University Hospital Virgen de la Victoria, Málaga, Spain.
Susana
S
Gómez-Ramírez
Pharmacology, School of Medicine, University of Málaga, Málaga, Spain.
José
J
Pavía
Research Institute, University Hospital La Paz (IdiPAZ), Madrid, Spain.|Clinical Pharmacology, School of Medicine, Autonomous University of Madrid, Madrid, Spain.
Alberto M
AM
Borobia
Research Institute, University Hospital La Paz (IdiPAZ), Madrid, Spain.|Haematology and Haemotherapy, Research Institute of Aragón, General Hospital San Jorge, Huesca, Spain.
José A
JA
García-Erce
Transfusion Medicine, School of Medicine, University of Málaga, Málaga, Spain.
Manuel
M
Muñoz
D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018798:Anemia, Iron-Deficiency / Q000188:drug therapy* / Q000191:economics*; D003365:Costs and Cost Analysis; D004636:Emergency Service, Hospital / Q000191:economics*; D005260:Female; D005290:Ferric Compounds / Q000008:administration & dosage* / Q000191:economics*; D006801:Humans; D007501:Iron / Q000008:administration & dosage; D008297:Male; D008320:Maltose / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics; D008875:Middle Aged
D005290:Ferric Compounds; C522335:ferric carboxymaltose; D008320:Maltose; D007501:Iron