Korean J Hematol.  2008 Jun;43(2):89-97. 10.5045/kjh.2008.43.2.89.

Economic Evaluation of Iron Chelation Agents: Oral Deferasirox versus Infusional Deferoxamine

• Kim JH
• Kim YH

• KMID: 2252201
• DOI: http://doi.org/10.5045/kjh.2008.43.2.89

Abstract

BACKGROUND: Patients with transfusional iron overload have relied on treatment with deferoxamine, a standard chelating agent. Deferoxamine is administered by intravenous or subcutaneous infusion over an 8~12 hour period 5~7 times per week; however, administration of deferoxamine may lead to poor compliance and reduced quality of life in patients. The use of deferasirox, a once daily oral chelation agent, was recently approved. We conducted an economic evaluation of these two iron-chelating medications in transfusion-dependent patients.
METHODS
The efficacy of oral deferasirox and infusion deferoxamine was assumed equal based on clinical trials of non-inferiority with the administration of 20mg/kg/day deferasirox versus 40mg/kg/day deferoxamine. Depending on the methods utilized for measuring administration time, travel time and convenience between the use of infusion and oral therapy, either cost analysis or cost-utility analysis was undertaken, respectively. Cost analysis included determination of direct medical costs (drug costs and administration costs), non-medical costs (travel costs), and indirect costs (productivity loss associated medical utilization). For cost utility analysis, the cost per QALYs (quality-adjusted life years) was calculated based on costs subtracting indirect costs (productivity loss) and gains of QALYs between the two agents.
RESULTS
Deferasirox therapy resulted in a cost savings per patient of 23,471,777 Korean won based on cost analysis. Based on cost utility analysis, the cost per QALYs gained was -398,576 Korean won (4,527,819 Korean won savings with a gain of 11.5 QALYs per patient).
CONCLUSION
The results of cost analysis and cost utility analysis of the use of oral deferasirox versus infusion deferoxamine showed that deferasirox is a more economical and potentially socially beneficial iron-chelating agent in Korea.

Keyword

Deferasirox; Deferoxamine; Iron chelating agents; Cost analysis; Cost utility analysis

MeSH Terms

Benzoates
Compliance
Cost Savings
Costs and Cost Analysis
Deferoxamine
Humans
Income
Infusions, Subcutaneous
Iron
Iron Chelating Agents
Iron Overload
Quality of Life
Triazoles
Benzoates
Deferoxamine
Iron
Iron Chelating Agents
Triazoles

Figure

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  Fig. 1 The structure of economic evaluation.

Reference

1). Cappellini MD., Cohen A., Piga A, et al. A phase 3 study of deferasirox (ICL670), a once-daily oral iron chelator, in patients with beta-thalassemia. Blood. 2006. 107:3455–62.

2). Gabutti V., Piga A. Results of long-term iron-chelating therapy. Acta Haematol. 1996. 95:26–36.

3). Piga A., Galanello R., Forni GL, et al. Randomized phase II trial of deferasirox (Exjade, ICL670), a once-daily, orally-administered iron chelator, in comparison to deferoxamine in thalassemia patients with transfusional iron overload. Haematologica. 2006. 91:873–80.

4). Neufeld EJ. Oral chelators deferasirox and deferiprone for transfusional iron overload in thalassemia major: new data, new questions. Blood. 2006. 107:3436–41.

5). Cappellini MD., Bejaoui M., Agaoglu L, et al. Prospective evaluation of patient-reported outcomes during treatment with deferasirox or deferoxamine for iron overload in patients with beta-thalassemia. Clin Ther. 2007. 29:909–17.

6). Vichinsky E., Pakbaz Z., Onyekwere O, et al. Patient-reported outcomes of deferasirox (Exjade? ICL670) versus deferoxamine in sickle cell disease patients with transfusional hemosiderosis. Substudy of a randomized open-label phase II trial. Acta Haematol. 2008. 119:133–41.

7). Osborne RH., De Abreu Lourenco R., Dalton A, et al. Quality of life relatedto oral versus subcutaneous iron chelation: a time trade-off study. Value in Health. 2007. 10:451–6.

8). Fischer R., Longo F., Nielsen P., Engelhardt R., Hider RC., Piga A. Monitoring long-term efficacy of iron chelation therapy by deferiprone and desferriox-amine in patients with beta-thalassaemia major: application of SQUID biomagnetic liver susceptometry. Br J Haematol. 2003. 121:938–48.

9). Delea TE., Sofrygin O., Thomas SK., Baladi JF., Phatak PD., Coates TD. Cost effectiveness of once-daily oralchelation therapy with deferasirox versus infusional deferoxamine in transfusion-dependent thalassaemia patients: US healthcare system perspective. Pharmacoeconomics. 2007. 25:329–42.

10). Canatan D., Temimhan N., Dincer N., Ozsancak A., Oğuz N., Temimhan M. Continuous desferoxamine infusion by an infusor in thalassaemia major. Acta Paediatr. 1999. 88:550–2.

11). Chan GC., Ng DM., Fong DY., Ha SY., Lau YL. Comparison of subcutaneous infusion needles for transfusion-dependent thalassemia patients by the intrapersonal cross-over assessment model. Am J Hematol. 2004. 76:398–404.

12). Sharma JB., Jain S., Mallika V, et al. A prospective, partially randomized study of pregnancy outcomes and hematologic responses to oral and intramuscular iron treatment in moderately anemic pregnant women. Am J Clin Nutr. 2004. 79:116–22.

13). Rossini M., Braga V., Gatti D., Gerardi D., Zamberlan N., Adami S. Intramuscular clodronate therapy in postmenopausal osteoporosis. Bone. 1999. 24:125–9.

14). Varsano I., Volovitz B., Horev Z, et al. Intramuscular ceftriaxone compared with oral amoxicillin-clavulanate for treatment of acute otitis media in children. Eur J Pediatr. 1997. 156:858.

15). JundtJW. Browne BA., Fiocco GP., Steele AD., Mock D. A comparison of low dose methotrexate bioavail-ability: oral solution, oral tablet, subcutaneous and intramuscular dosing. J Rheumatol. 1993. 20:1845–9.