Budget Impact Analysis of Ferric Derisomaltose for Heart Failure in a Rapidly Aging Regional Population

Area of Science:

• Health Economics
• Cardiology
• Pharmacoeconomics

Background:

• Heart failure with reduced ejection fraction (HFrEF) presents a substantial clinical and economic challenge in Malaysia, particularly in Perak.
• Iron deficiency (ID) is a common comorbidity in HFrEF, linked to increased hospitalizations.
• Current international guidelines advocate for intravenous ferric derisomaltose (FDI), but its economic feasibility in Perak's public hospitals is unassessed.

Purpose of the Study:

• To estimate the 3-year budget impact of implementing intravenous ferric derisomaltose (FDI) therapy for patients with HFrEF and ID in Perak's public hospitals.
• To evaluate the economic viability of FDI from the Malaysian Ministry of Health's perspective.
• To compare the costs and savings associated with FDI against the current standard of care.

Main Methods:

• An Excel-based budget impact model was developed to compare a 'World-with-FDI' scenario against the current standard of care (no intravenous iron).
• The study utilized a 3-year time horizon (2026-2028), incorporating demographic projections, regional prevalence data (Asian-heart failure [HF], MY-HF), and public sector utilization rates to define the eligible cohort.
• Clinical efficacy data (hospitalization rate ratio) and dosing parameters were sourced from the IRONMAN trial, alongside drug acquisition and hospitalization costs. Deterministic one-way sensitivity analyses were performed.

Main Results:

• The phased introduction of FDI required a minimal initial investment of RM 2686 in Year 1.
• During the maintenance phase, savings from reduced hospitalizations substantially exceeded drug acquisition costs, resulting in net savings of RM 442,279 in Year 2 and RM 889,529 in Year 3.
• The cumulative 3-year savings reached RM 1.33 million. Sensitivity analyses indicated high sensitivity to hospitalization costs, with strategic selection of high-risk patients potentially increasing Year 3 savings to over RM 2 million.

Conclusions:

• Intravenous ferric derisomaltose (FDI) is a cost-saving intervention for managing heart failure with reduced ejection fraction (HFrEF) and iron deficiency (ID) in Perak's public healthcare system.
• Strategic patient selection, focusing on high-utilization cohorts, is crucial for maximizing financial sustainability and realizing the full economic benefits of FDI.
• The single-visit dosing administration of FDI offers potential operational efficiencies within the public hospital setting.