Cost minimization analysis between iron saccharate and ferric carboxymaltose in the treatment of iron deficiency anemia: a real life cohort study

Background Approximately 20 to 30% of the Brazilian population is anemic. Specialized hospitals tend to serve a population with a high incidence of iron deficiency anemia, routinely administering intravenous (IV) iron therapy. Ferric hydroxide sucrose (FHS) and ferric carboxymaltose (FCM) are IV iron compounds used in Brazil. Due to differences in administration time, daily dose limits, pharmacodynamics, and vial prices, it is necessary to develop an economic feasibility analysis to better allocate resources. This study aims to deepen the discussion on public health management in economically peripheral regions such as the Northeast, addressing health economics as a strategic response. Methods This is a real-world, retrospective cohort study of cost-minimization conducted at a hospital specialized in gynecology and obstetrics in Northeast Brazil. A total of 834 records of IV iron usage were evaluated from 09/13/2022 to 04/25/2024, with this sample selected for convenience. All patients underwent treatment for iron deficiency anemia with FCM or FHS. The acquisition cost per vial for FCM and FHS was $97,69 and $1,82, respectively. Among the variables computed, following economic evaluation guidelines, were vial cost, infusion cost, outpatient consultation, daily medical clinical hospitalization cost, and follow-up cost, based on the institution's actual costs and national databases. Results Of the 834 records, 644 were for FHS and 190 for FCM. A total of $37.124,69 was spent on acquiring FCM and $11.766,77 on FHS. The minimum individual cost for treating iron deficiency anemia is $257,90 for FCM and $641,07 for FHS. The cost of treating 644 patients with FHS was $412.849,08, while the estimated cost of treatment with FCM for the same 644 patients would be $166.087,60. Conclusion Treatment of iron deficiency anemia with FHS proved to be approximately 148% more expensive. The use of FCM leads to cost reductions, allowing for better allocation of public financial resources, as well as shorter hospitalization times and fewer invasive procedures.