BACKGROUND: Ferric carboxymaltose injection’s indication in the United States (US) has been expanded to include treatment for iron deficiency (ID) in adult patients (≥ 18 years) with heart failure (HF) and New York Heart Association (NYHA) class II/III to improve exercise capacity.
OBJECTIVES: To estimate the budget impact (difference in total and per-member per-month costs) to a third-party payer in the US (e.g., a commercial payer and/or Medicare) of managing ID in adult patients with HF with NYHA class II/III before and after the expansion of ferric carboxymaltose injection’s indication.
METHODS: A budget-impact model was developed in Excel to estimate the cost impact of the indication expansion. The population eligible for treatment consisted of adults who are iron deficient with HF and NYHA class II/III in need of treatment to improve exercise capacity. The scenarios compared were a market with expanded approval and a market without expanded approval. Costs considered were drug acquisition, drug administration, adverse events, and other healthcare resource utilization (HCRU) over a time horizon of 2 years. Model inputs were informed by data from the CONFIRM-HF study, a retrospective claims analysis of patients with HF, published literature, and model assumptions.
RESULTS: For a blended plan of commercial and Medicare patients, 11,828 adults were eligible for treatment per 1 million lives covered. In the scenario in which ferric carboxymaltose injection received approval for the expanded indication and experienced an increase in uptake, there was an incremental per-member per-month cost reduction of $0.11 in the first year and $0.23 in the second year compared with the market without approval and without an increase in uptake. This translates to approximately $1.3 million and $2.7 million in total cost reductions each year, respectively, per 1 million lives covered. Drug acquisition costs increased but were more than completely offset by cost reductions in drug administration, adverse events, and other HCRU. A majority (93.1%) of decreased costs was attributable to reduction in other HCRU. One-way sensitivity analyses showed that model results were robust to reasonable changes in model parameters.
CONCLUSIONS: The expansion of ferric carboxymaltose injection’s indication to include the treatment of ID in adult patients with HF and NYHA class II/III to improve exercise capacity would result in cost reductions for a third-party US payer due to reduced costs from hospitalizations and emergency room visits related to worsening HF.
