Background Standard postoperative anaemia management includes oral iron or intravenous iron supplementation (iron sucrose complex, ISC), erythropoietin therapy and blood transfusion. Introduction of a new intravenous iron formulation (ferric carboxymaltose, FCM), more expensive than ISC but with simplified administration modalities, could have economic consequences for hospitals.
Purpose To assess the budget impact of introducing FCM in the current practise for treating postoperative anaemia in orthopaedic surgery.
Materials and Methods A budget impact model (BIM) was built from a hospital perspective. Study population consisted of patients who underwent total hip or knee replacement in 2011. Costs are estimated by micro-costing for treatment costs and questionnaire for nursing costs. A reference case is based on the present patient case-mix. Simulations consider different substitutions: simulation A 100% ISC for FCM, simulation B 100% ISC and 50% oral iron for FCM and simulation C 100% ISC and 100% oral iron for FCM. One-way sensitivity analysis is applied to simulations.
Results Population: 314 patients (210 women) underwent 327 operations (205 total hip replacements), mean age was 71.6 years. Costs per treatment: oral iron €0.57, ISC €60.48, FCM €82.46 and transfusion €431.13 (no patient received erythropoietin treatment during hospitalisation). Average costs per patient: reference case €161.63, simulation A €169.83, simulation B €195.93 and simulation C €219.85. Total costs per year: reference case €44 124.20, simulation A €46 364.85 (+5%), simulation B €53 488.94 (+21%) and simulation C €60 018.12 (+31%). Discussion: BIM is very sensitive to variations in transfusion rate, moderately sensitive to variations in treatment costs and insensitive to variations in nursing costs. Economically, simulation A is feasible for many patients, simulation B is feasible, but simulation C is not.
Conclusions FCM will be added to the hospital formulary. A further study is needed to define substitution modalities in the real-life situation. BIM has contributed to this decision-making process.
No conflict of interest.
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