1. ¹Department of Health Policy, Doris N. Grandon Center for Health Economics and Outcomes Research, Jefferson Medical College, Philadelphia, Pennsylvania, USA
2. ²Renal Division, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
3. ³Nephrology Division, Department of Medicine, NYU School of Medicine and NY Harbor VA Medical Center, New York, New York, USA
4. ⁴Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA

Correspondence: Laura T. Pizzi, Department of Health Policy, Doris N. Grandon Center for Health Economics and Outcomes Research, Jefferson Medical College, 1015 Walnut Street—Suite 319, Philadelphia, Pennsylvania 19107, USA. E-mail: laura.pizzi@jefferson.edu

Received 22 February 2008; Revised 25 June 2008; Accepted 29 July 2008; Published online 1 October 2008.

Abstract

A subgroup of hemodialysis patients experience high serum ferritin and low tansferrin saturation for reasons not clearly understood. Here we determined the economic impact of administering sodium ferric gluconate complex to patients with serum ferritin levels higher than 500 ng/ml and a transferrin saturation less than 25% based on the Dialysis Patients Response to IV Iron with Elevated Ferritin (DRIVE) study and its extension, DRIVE II. A cost effectiveness model was developed, consistent with the DRIVE studies, using decision analysis with a 12-week time horizon. The primary effectiveness measure was the mean hemoglobin increase in the intent to treat patient groups comparing epoetin with or without sodium ferric gluconate complex. Costs were computed using projected 2007 US Medicare reimbursements for the treatments and for serious adverse events, with the effectiveness factored by the increase in hemoglobin. The net savings for sodium ferric gluconate complex plus epoetin treatment was $1390 compared to epoetin alone for each g/dl hemoglobin increase over 12 weeks of study. Sensitivity analyses were performed to test the impact of change in the variables (using medians or means and actual 2005 or projected 2007 Medicare reimbursements) and these affirmed the robustness of the model. Our study shows that treatment of patients with high ferritin and low transferrin saturation levels, as defined in DRIVE, with sodium ferric gluconate complex and epoetin resulted in significant savings compared to epoetin alone.