• CONTEXT
  • STUDY
  • HOSPITAL COST SAVINGS
  • SIMULATOR
  • STUDY DESIGN
  • RESULTS
  • CONCLUSION

HOSPITAL COST SAVINGS SIMULATOR

INSIGHTS FROM A PORTUGUESE STUDY

“CLINICAL, ECONOMICAL AND SAFETY IMPACT OF FERRIC CARBOXYMALTOSE
USE IN PATIENT BLOOD MANAGEMENT PROGRAMME IN PORTUGUESE
NATIONAL HEALTH SERVICE HOSPITALS”

Ferinject® is indicated for the treatment of iron deficiency when oral iron preparations are ineffective, oral iron preparations cannot be used or there is a clinical need to deliver iron rapidly.
The diagnosis of iron deficiency must be based on laboratory tests.1
Preoperative anaemia is associated with2,3

Longer

hospital stay

Higher number

of RBC
transfusion

Increased
Morbidity

postoperatively

Higher
Mortalidade

postoperatively

IT IS IMPORTANT TO IMPLEMENT A:

PATIENT BLOOD MANAGEMENT
PROGRAM (PBM)4

There are global and national recommendations for implementation of PBM:
WHO: POLICY BRIEF4 NATIONAL DECREE DESPACHO Nº12310/20215

Clinical, economical and safety impact of ferric carboxymaltose use in
Patient Blood Management programme in Portuguese National Health Service hospitals6

Study funded by CSL Vifor published at Scientific Reports

OBJECTIVE

To assess the impact of FCM (ferric carboxymaltose) in patients with ID/IDA

in preoperative hemoglobin (Hb) optimization in patients from elective orthopedic, cardiac and colorectal surgery in Portuguese hospitals.

7 PORTUGUESE
HOSPITALS
INVOLVED
. Centro Hospitalar do Tâmega e Sousa
. Centro Hospitalar de Entre Douro e Vouga
. Centro Hospitalar de Vila Nova de Gaia e Espinho
. Unidade Local do Nordeste
. Centro Hospitalar Universitário Cova da Beira
. Centro Hospitalar e Universitário de Lisboa
. Central: Hospital Curry Cabral
. Hospital Prof
. Doutor Fernando Fonseca
Design: Observational, retrospective, multicenter cohort study
Data: from elective orthopaedic, cardiac and colorectal surgeries that took place between 2017 and 2020
Target population: Male and female adults with anaemia and/or iron deficiency undergoing elective surgery - 405 patients (♂ - 209 (51.6%) ♀ - 196 (48.4%) with an average age of 72.3 years).
Limitations: mainly due to the sample size.
Limitations: Another important limitation was the large amount of missing laboratory data, such as those related to post-transfusion Hb assessment, as well as the high percentage of cases without serum iron markers. This lack of information conditioned the analysis of the ABT group, where the absence of these data predominated, and it was not possible to perform statistical tests in the same way as for the FCM group. All these missing data hampered more robust statistical studies in the ABT group.

CLINICAL
OUTCOMES

ECONOMIC
RESULTS

  • Direct costs
  • Indirect costs
  • Direct and indirect costs

CONCLUSION6

In patients undergoing elective surgery, preoperative treatment with FCM was associated with a potential:
IMPROVEMENT
in patients’
clinical outcomes
REDUCED
length of hospital
stay
-2.8 days
REDUCED
Infection rate
REDUCED
use of
blood transfusion
REDUCTION
OF COSTS

-19% vs. transfused
patients

1,037€ savings per patient treated with FCM

This study shows a potential clinical and economic benefit in the use of FCM.
Translating into potential clinical improvements for the patient and economic savings for the hospital.
FCM - Ferric carboxymaltose; HB - Hemoglobin; ID/IDA: iron deficiency/iron deficiency anaemia

POTENTIAL REDUCTION OF COSTS FOR THE NHS UP TO €18.6 M7

POTENTIAL SAVINGS TO BE SECURED7

IN THE VARIOUS HOSPITAL CENTERS
(€; hospitals with savings >€200k)
ULS Coimbra
4348
4348
1610
1163
€887,825
ULS S. José
3848
3848
2050
749
€809,827
ULS São João
1730
1730
2076
665
€627,049
ULS Santa Maria
1414
1414
1868
419
€530,650
ULS Porto
3482
3482
74
793
€444,577
ULS Braga
1872
1872
1641
825
€443,452
ULS Gaia Espinho
1226
1226
1284
763
€443,043
ULS Tâmega e Sousa
1789
1789
991
933
€402,358
ULS Aveiro
1774
1774
1206
473
€352,983
ULS Alto Ave
1592
1592
664
572
€335,605
ULS Trás-os-Montes e Alto Douro
1416
1416
286
1069
€284,288
ULS Lisboa Ocidental
738
738
871
370
€281,732
ULS Alto Minho
1190
1190
729
820
€279,994
ULS Amadora Sintra
709
709
1203
805
€277,745
ULS Matosinhos
1173
1173
969
434
€263,332
ULS Entre Douro e Vouga
1268
1268
600
655
€257,914
ULS Alentejo Central
867
867
264
570
€245,953
ULS Algarve
1023
1023
634
728
€243,807
ULS Viseu Dão Lafões
1409
1409
436
534
€243,193
ULS Leiria
947
947
530
853
€238,184
ULS Almada Seixal
1033
1033
743
473
€229,904
ULS Loures Odivelas
786
786
875
571
€228,166
ULS Médio Tejo
433
433
967
573
€217,126
Hospital de Cascais
1076
1076
460
541
€212,321
ULS Estuário do Tejo
1031
1031
458
425
€195,659
ULS Médio Ave
1398
1398
0
479
€191,876
ULS Funchal
1285
1285
361
0
€183,290
ULS Lezíria
690
690
408
492
€162,538
ULS Cova da Beira
842
842
376
276
€161,618
ULS Arrábida
737
737
50
471
€161,413
ULS Arco Ribeirinho
460
460
692
395
€158,142
ULS Guarda
357
357
336
580
€144,546
ULS Nordeste
216
216
448
685
€137,902
ULS Castelo Branco
261
261
427
384
€125,941
ULS Baixo Alentejo
314
314
233
593
€116,537
ULS Oeste
379
379
0
638
€103,963
ULS Póvoa de Varzim Vila do Conde
689
689
0
293
€100,385
ULS Baixo Mondego
345
345
315
300
€98,136
ULS Norte Alentejano
162
162
279
473
€93,434
ULS Litoral Alentejano
61
61
198
269
€53,975
ULS Barcelos Esposende
0
0
23
288
€31,792
Hospital Dr. Francisco Zagalo
0
0
160
0
€16,356
  • Potential savings to be captured by the SNS of at least 11.0 million Euros
  • Potential savings depend on the % of patients treated with FCM (assumed the ENSP study mean of 41%) and the surgical activity volume.
Gynecology and Obstetrics
Cardiac
Colorectal
Orthopaedic

Em contexto pré-operatório, a otimização da anemia com Ferinject®
(Carboximaltose férrica) traduz-se em ganhos em saúde para o doente e numa
poupança económica para o hospital:5

Menos transfusões
sanguíneas
Menos 2,8 dias
de internamento
Menor taxa
de infeção
Poupança de 1037€
por doente

Por isso, é fundamental:

DIAGNÓSTICO ATEMPADO

Todos os doentes devem ser avaliados com
hemograma e metabolismo do ferro nas 3 a 4 semanas
prévias à cirurgia eletiva.6

TRATAMENTO ADEQUADO

É FUNDAMENTAL IMPLEMENTAR:

Uma estratégia Transfusional Restritiva2

Correlacionada com
melhores desfechos
Transfusão no doente
cirúrgico adulto está indicada
para Hb <7,5 g/dL2

IT IS CRITICAL TO IMPLEMENT:

A Patient Blood Management (PBM)
program4

PILLAR 1
Detection and treatment
of anaemia and iron
deficiency.
PILLAR 2
Minimization of blood
loss and optimization
of coagulation.
PILLAR 3
Optimize patient
tolerance for anaemia.

CLINICAL OUTCOMES6

FCM GROUP

Received 500mg or 1000mg FCM prior to surgery
FCM administered 4 to 6 weeks prior to surgery:

In the FCM preoperative cohort, there was an increase in patients with normal preoperative Hb, from 14.4 to 45.7%, before and after FCM

Decreased cases of moderate anaemia from 31.7% to 9.6%

Absence of cases of severe anaemia (However, prior to treatment with FCM there was 7.7% of severe anaemia)

BLOOD TRANSFUSION GROUP

patients treated with ABTs on demand

In the group blood transfusion, there were significant differences between pre- and postoperative Hb levels (p<0.001)

In 44.1% there was a shift from mild anaemia prior to transfusion to moderate anemia in the postoperative period

In the correction of ID/IDA with FCM compared to blood transfusions, there was a significant difference in the
increase of Hb and ferritin levels (p<0.001)
FCM - Ferric carboxymaltose; Hb - Hemoglobin; ID/IDA: iron deficiency/iron deficiency anaemia

ECONOMIC RESULTS

Direct costs6

(FCM costs and blood transfusion cost)

The average cost of FCM per patient was €267.18 and the average cost of blood components was €440.17.
The group treated with FCM had lower direct costs, translating to an average savings per patient of more than €170.
FCM - Ferric carboxymaltose
The economic analysis had a significant set of limitations and was specific to the context of the study car- ried out. The cost estimate focused only on the direct costs (FCM utilisation and ABTs) and indirect costs of hospitalisation. It did not consider other costs and benefits that may exist, such as a reduction in the rate of complications, or changes in the consumption of other therapies. Moreover, the results rely on the assumption that the two groups of patients were comparable. However, if this assumption was violated, then patient selection between groups may have introduced a bias in the estimates.

ECONOMIC RESULTS

Indirect Costs6

(Duration of hospital stay)

In terms of length of hospital stay, there was a significant difference between the group who received FCM
and the group who received blood transfusions (p<0.001) according to Mann-Whitney-Wilcoxon test.
FCM - Ferric carboxymaltose

ECONOMIC RESULTS

Patients treated with FCM had a reduction in costs
(direct and indirect) of 19%; which corresponds to
a saving of €1,037 per patient6

In patients treated with FCM, direct and indirect costs were lower.
The cost difference was estimated at €1,037 per patient, which represents 19% of the total cost.
FCM - Ferric carboxymaltose