Original Article

Pharmacoeconomics and Utilization of Intravenous Iron Sucrose in a Tertiary Care Hospital

Abstract

Background: Rational utilization of parenteral iron with meticulous calculated doses will promote appropriate utilization of healthcare resources. The aim is to study utilization of intravenous Iron Sucrose at patient level and hospital level. 
Methods: This prospective-observational study was conducted over 6 months. Case-records of 125 indoor patients were reviewed for intravenous (IV) Iron Sucrose prescription and patient details and treatment details for patients were procured. 
Results: 125 patient records were divided in (Antenatal care and Non Antenatal care) ANC and Non ANC groups; and their Mean age was 36(S.D ± 16) years. IV Iron Sucrose was prescribed the most in anemic pregnant patients 41(32.8%) followed by severely debilitated patients on other injectable drugs 37(6%). The Total administered dose was more than the Standard calculated dose in an alarming 84(67.2%) of the patients. Utilisation of IV iron sucrose in Defined Daily Dose per 100 bed days (DDD/100 bed days) was found to be 0.42 in total patients whereas it was 0.59 in ANC and 0.36 in Non ANC groups. Conclusion: This research highlighted that overutilization and administering more than the required dose of IV iron sucrose, could be effectively tackled by calculation of its standard dose by Ganzoni’s formula. Studying the monthly trends and comparing utilization of parenteral iron with the help of DDD/100 bed days by hospitals can help in comparing utilization and also assist for budgetary preparedness of hospitals. There is also a dire need to formulate universally accepted guidelines for the use of parenteral iron in general adult population.

1. World Health Organization, Introduction to Drug Utilization Research. Geneva: WHO, 2003; 6-48.
2. Silverstein SB, Rodgers GM. Parenteral iron therapy options. Am J Hematol. 2004; 76(1): 74–7.
3. Gozzard D. When is high-dose intravenous iron repletion needed? Assessing new treatment options. Drug Des Devel Ther. 2014; 5:51-60.
4. Beguin Y, Jaspers A. Iron sucrose - characteristics, efficacy and regulatory aspects of an established treatment of iron deficiency and iron-deficiency anemia in a broad range of therapeutic areas. Expert Opin Pharmacother.. 2014; 15(14): 2087–2103.
5. Joshi AD, Holdford DA, Brophy DF, et al. Utilization Patterns of IV Iron and Erythropoiesis Stimulating Agents in Anemic Chronic Kidney Disease Patients: A Multihospital Study. Anemia. 2012; 248430.
6. https://en.wikipedia.org/wiki/Erythropoiesis-stimulating_agent accessed at 10.38 am on 21/12/2022.
7. Macdougall IC. Iron supplementation in the non-dialysis chronic kidney disease (ND-CKD) patient: oral or intravenous? Curr Med Res Opin. 2010; 26(2): 473–82.
8. Addendum AG. The safety of iron dextran and a comparison with iron sucrose for intravenous use: a short report to the world health organization advisory committee on the safety of medicines. 2004; 1-5.
9. Patel Varsha. Morbidity and drug utilization pattern among admitted pregnant anemic women and to find out rationality of drug by using Indian guidelines. IJBCP. 2014; 10: 5455/2319-2003.
10. Perewusnyk G, Huch R, Huch A, Breymann C. Parenteral iron therapy in obstetrics: 8 years experience with iron-sucrose complex. Br J Nutr. 2002; 88(1): 3–10.
11. Fishbane S. Safety in iron management. Am J Kidney Dis. 2003;41(5 Suppl):18-26.
12. Laman CA, Silverstein SB, Rodgers GM. Parenteral iron therapy: a single institution's experience over a 5-year period. J Natl Compr Canc Netw. 2005;3(6):791-5.
13. Koch TA, Myers J Goodnough. Intravenous Iron Therapy in Patients with Iron Deficiency Anemia: Dosing Considerations. Anemia. 2015; 763576.
14. Chalco JP, Huicho L, Alamo C, et al. Accuracy of clinical pallor in the diagnosis of anaemia in children: a meta-analysis. BMC Pediatr. 2005; 5: 46–46.
15. Lisa Sullivan, PhD Professor of Biosatistics. Power and Sample Size Determination .Boston University School of Public Health.2002.www.hindaw8.com.
16. Arya R, Antonisamy B, Kumar S. Sample size estimation in prevalence studies. Indian J Pediatr. 2012 Nov;79(11):1482-8.
17. https://www.socscistatistics.com/ . Accessed on 26/12/2023 at 12.30pm.
18. Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharm Ther. 1981; 30(20): 239-45.
19. https://www.who.int/tools/atc-ddd-toolkit/indicators . Accessed on 26/12/2023 at 2pm.
20. Kaur R, Kant S, Subramanian M, Kamble BD, Malhotra S, Haldar P. Effectiveness of intravenous iron sucrose therapy in routine antenatal care for the treatment of moderate to severe anemia among pregnant women attending a secondary care hospital in north India: a retrospective analysis. Cureus. 2022; 14(3) :e23603.
21. Perewusnyk G, Huch R, Huch A, Breymann C. Parenteral iron therapy in obstetrics: 8 years experience with iron-sucrose complex. Br J Nutr. 2002; 88:3–10.
22. Kriplani A, Mahey R, Dash BB, Kulshreshta V, Agarwal N, Bhatla N. Intravenous iron sucrose therapy for moderate to severe anaemia in pregnancy. Indian J Med Res. 2013; 138(1): 78-82
23. Hong C, Xu X, Feng R, et al. Use of iron sucrose injection in anemia patients with reduced serum iron concentration during hospitalizations of digestive and liver diseases. Ann Palliat Med. 2021 Feb; 10(2): 1145-1153.
24. Shrivastava D, Inamdar S, Bhute S, Singh A. Effectiveness of intravenous iron sucrose in management of iron-deficient anemia of pregnancy at rural hospital set up. J Obstet Gynaecol India. 2012; 62(2):154-7.
25. Brownlee T, Dersch-Mills D, Cummings G, et al. Patient Factors Associated with Prescribing of Iron for IV Administration: A Descriptive Study. Can J Hosp Pharm. 2021; 74(1): 50-56.
26. Basha A, Ibrahim MIM, Hamad A, et al. Efficacy and cost effectiveness of intravenous ferric carboxymaltose versus iron sucrose in adult patients with iron deficiency anaemia. PLoS One. 2021;16(8) :e0255104.
27. Kattini R, Poirier J, Minty L, et al. Intravenous iron therapy in a rural hospital: A retrospective chart review. Can J Rural Med. 2021; 26(3):123-127.
28. Macdougall IC, White C, Anker SD, et al.PIVOTAL Investigators and Committees. Intravenous Iron in Patients Undergoing Maintenance Hemodialysis. N Engl J Med. 2019; 380(5): 447-58.
29. Aronoff GR, Bennett WM, Blumenthal S, et al.United States Iron Sucrose (Venofer) Clinical Trials Group. Iron sucrose in hemodialysis patients: safety of replacement and maintenance regimens. Kidney Int. 2004; 66(3):1193-8.
30. Hye RA, Sayeeda N, Islam GMR, Mitu JF, Zaman MS. Intravenous iron sucrose vs. blood transfusion in the management of moderate postpartum iron deficiency anemia: A non-randomized quasi-experimental study. Heliyon. 2022; 8(2):e08980..
31. Pollock RF, Muduma G. A budget impact analysis of parenteral iron treatments for iron deficiency anemia in the UK: reduced resource utilization with iron isomaltoside 1000. Clinicoecon Outcomes Res. 2017; 9:475-483.
32. Bharati P, Som S, Chakrabarty S, Bharati S, Pal M. Prevalence of anemia and its determinants among nonpregnant and pregnant women in India. Asia Pac J Public Health. 2008; 20(4):347-59.
33. Kaushal S, Priya T, Thakur S, Marwaha P, Kaur H. The etiology of anemia among pregnant women in the hill state of himachal pradesh in north India: a cross-sectional study. Cureus. 2022; 14(1):e21444.
34. National Family Health Survey. (2016). Accessed: 26/12/2023 at 5pm: http://rchiips.org/nfhs/factsheet_nfhs-4.shtml
35. Al RA Md, Unlubilgin E Md, Kandemir O, et al. Intravenous versus oral iron for treatment of anemia in pregnancy Obstet Gynecol. 2005; 106:1335–40.
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IssueVol 12, No 1 (Winter 2024) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/jpc.v12i1.16026
Keywords
Iron Deficiency Anemia; Iron Sucrose; Drug Utilization Research

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How to Cite
1.
Kadam P, Tiwari S, Daswani B, Aher K. Pharmacoeconomics and Utilization of Intravenous Iron Sucrose in a Tertiary Care Hospital. J Pharm Care. 2024;12(1):17-23.