Traitement de l'anémie ferriprive par fer intraveineux en milieu hospitalier en France: Impact sur les pratiqueset les coûts de prise en charge

What is known? Parenteral iron-replacement therapy (IRT) is the preferred option to treat efficiently iron deficiency (ID) in ID anemia (IDA) patients. Iron sucrose (IS/ISS) and ferric carboxy maltose (FCM) are the main available injectable iron preparations for the treatment of IDA. Due to reports of anaphylactic reactions, the prescription and the administration of injectable irons is now restricted to the hospital to ensure safety monitoring. Study objectives were, on the one hand, to assess the use of parenteral IRT by anesthesiologists in orthopedic or gynecological surgery patients with ID/IDA, and, on the other hand, to deduce the impact of the costs of management in the French hospital setting. Methods. We used the validated methodology of case-vignettes with four different fictive clinical cases built by randomization of clinical parameters. Key parameters of interest were: Context of orthopedics or gynecology and patient situation, either inpatient stay/pre-surgery or outpatient stay/post-surgery. The selection of either IS/ISS or FCM was left to participant's decision and the iron administration was documented: Iron dose per infusion, the total iron dose, number of infusions and nursing time required for each infusion. Results. Of 94 active participating physicians, 40 use IS/ISS more frequently in their routine practice and 54 choose FCM. In view of the simulations, the therapeutic choices made by the doctors led to 134 cases of IDA treated with IS/ISS and 242 cases treated with FCM. Mean number of infusions was lower with FCM (1.3_0.5) than with IS/ISS (2.1_0.7). The estimated nursing time spent by infusion: 72.5_170.3 minutes for an inpatient stay and 73.4_186.5 minutes for an outpatient stay with FCM and 86.1_51.5 minutes and 94.8_65.6 minutes with IS/ISS for inpatient and outpatient stay, respectively. Conclusion. Compared to IS/ISS, the use of FCM could result in an organizational simplification patient management due to reduced number of infusions, hospitalization duration and health professionals mobilization. Considering transportation costs and administrative costs, the total cost of treating IDA with FCM might be lower than that of IS/ISS.