The significance of hypophosphatemia in deciding on an optimal clinical choice of parenteral iron therapy in patients with chronic inflammatory bowel disease in Slovenia: an umbrella review and economic evaluation

Hren, Rok (avtor), Dóczi, Tamás (avtor), Országh, Erika (avtor), Kocjan, Tomaž (avtor)

Background/Objectives: Iron-deficiency anemia (IDA) is a common extraintestinal complication of inflammatory bowel disease (IBD). Among high-dose intravenous (IV) iron options, ferric carboxymaltose (FCM) carries a higher risk of treatment-emergent hypophosphatemia than ferric derisomaltose (FDI), with potential clinical consequences. Slovenia’s healthcare setting, characterized by very low IV iron infusion tariffs and recent pricing in which FCM is substantially less expensive than FDI, warrants a setting-specific cost effectiveness evaluation. Methods: We integrated two methodological components: (i) a payer-perspective cost-effectiveness analysis using a patient-level microsimulation model with (ii) an umbrella review of systematic reviews and a targeted search of expert consensus statements on IV-iron-associated hypophosphatemia. Results: In the base case, FDI required fewer infusions than FCM (11.1 vs. 14.2 over 10 years) but generated only €95 in IV iron administration savings due to low tariffs, while drug procurement was €1166 higher with FDI than FCM. When incorporating the clinical impact of hypophosphatemia, incremental quality-adjusted life years (QALYs) were 0.136, yielding an incremental cost-effectiveness ratio (ICER) of €6590/QALY. The umbrella review consistently showed higher hypophosphatemia incidence with FCM (up to 92%) compared with other IV iron formulations (<10%), with recent recommendations emphasizing phosphate monitoring and risk mitigation through alternative formulations. Conclusions: Despite Slovenia’s low IV iron infusion tariffs and lower FCM price, FDI remained cost-effective in this model, largely due to its more favorable hypophosphatemia profile within the model. These findings suggest that hypophosphatemia risk should be considered when selecting IV iron therapy in routine IBD care.

• Jezik: Angleški jezik
• Ključne besede: anemia, hypophosphatemia, ferric carboxymaltose, ferric derisomaltose, pharmacoeconomic analysis
• Vrsta gradiva: Članek v reviji
• Tipologija: 1.01 - Izvirni znanstveni članek
• Organizacija: FMF - Fakulteta za matematiko in fiziko ; MF - Medicinska fakulteta
• Status publikacije: Objavljeno
• Različica publikacije: Objavljena publikacija
• Leto izida: 2026
• Št. strani: 28 str.
• Številčenje: Vol. 14, iss. 3, art. no. 393
• PID: 20.500.12556/RUL-179308
• UDK: 616.34
• ISSN pri članku: 2227-9032
• DOI: 10.3390/healthcare14030393
• COBISS.SI-ID: 267939075
• Datum objave v RUL: 10.02.2026

Gradivo je del revije

• Naslov: Healthcare
• Skrajšan naslov: Healthcare
• Založnik: MDPI
• ISSN: 2227-9032
• COBISS.SI-ID: 520110873

Licence

• Licenca: CC BY 4.0, Creative Commons Priznanje avtorstva 4.0 Mednarodna
• Povezava: http://creativecommons.org/licenses/by/4.0/deed.sl
• Opis: To je standardna licenca Creative Commons, ki daje uporabnikom največ možnosti za nadaljnjo uporabo dela, pri čemer morajo navesti avtorja.

Sekundarni jezik

• Jezik: Slovenski jezik
• Ključne besede: anemija, hipofosfatemija, železova karboksimaltoza, železova derizomaltoza, kronična vnetna črevesna bolezen, farmakoekonomska analiza

Projekti

• Financer: ARIS - Javna agencija za znanstvenoraziskovalno in inovacijsko dejavnost Republike Slovenije
• Številka projekta: P2-0348
• Naslov: Nove slikovno-analitske metode

• Financer: Ewopharma d.o.o.