Background and importance Iron deficiency anaemia is the most prevalent nutritional deficiency, affecting 29% of women. It is common in patients undergoing elective gynaecological surgeries (18.1%) and up to 90% postsurgery, increasing the risk of negative outcomes and need for transfusions. Oral iron, especially ferrous sulphate (FS), is used as the most common treatment and intravenous iron is solely used in severe cases. Ferric carboxymaltose (FCM) has demonstrated clinical benefits above FS but it is not widely used due mostly to its high cost.
Aim and objectives Our objective was to assess the value of FCM versus FS for anaemia in patients undergoing benign gynaecologic surgery in our country. We followed a multicriteria decision analysis (MCDA) by using the EVIDEM framework that allows the incorporation of multiple stakeholders, including patients.
Material and methods The framework was adapted considering evidence retrieved with a PICO-S-T search strategy and grey literature. Criteria/subcriteria were weighted by relevance and an evidence-based decision-making exercise was developed to assign a score from –5 (in favour of FS) to +5 (FCM) to each alternative for each criterion. Weights and scores were multiplied to obtain the value of intervention relative to each criterion/subcriterion. Values were added to calculate the Modulated Relative Benefit–Risk Balance (MRBRB) on a –1 (FS) to +1(FCM) scale. Ten stakeholders (gynaecology/obstetrics, haematology, anaesthesiology, midwifery, hospital pharmacy, hospital management, and patients and patients’ representatives) participated to collect different perspectives.
Results Weights were different among profiles: Compared Efficacy/Effectiveness (28% on average, 26.7% for hospital pharmacists (HP)) was the most relevant criterion. Compared Safety/Tolerability (18%, 24%) showed the greatest difference among all participants and HP. In general, participants were in favour of FCM in all criteria, as were HP, except for Economic Consequences (+1, –2.82). Lastly, the value of each criterion was calculated. The criterion with the highest impact was Compared Efficacy/Effectiveness (+0.178, +0.15). All profiles were in favour of FCM except Hospital Management. General MRBRB was +0.48; for HP, MRBRB was +0.34.
Conclusion and relevance From global and HP perspectives, FCM was the preferred alternative for treating anaemia in patients undergoing benign gynaecological surgery. MCDA can be a useful tool to incorporate diverse voices in the decision-making process, including professionals as well as patients.
Conflict of interest Corporate sponsored research or other substantive relationships: This study was funded by Vifor Pharma España S.L.U.