Attitude changes in prescribing intravenous iron supplementation in different settings at a hospital consortium in Italy.

BACKGROUND: Iron deficiency anaemia is a public health problem. In case oral iron treatment is ineffective, poorly tolerated or contraindicated, the intravenous route becomes the first choice. The aim of the study was to evaluate the shift between ferrous gluconate (FG) and ferric carboxymaltose (FCM) usage at our hospitals over the years. We also performed a cost comparison between pre and post-FCM availability periods, taking into account the acquisition costs of both intravenous iron and red blood cell units (PRBC). STUDY DESIGN AND METHODS: The amount and costs of FG and FCM released by hospital Pharmacy Services from 2010 to 2019 were analysed, along with the number of transfused PRBC units in the same timeframe. RESULTS: Overall, the proportion of FCM usage rose from 8.6 % in 2014 to 71.9 % in 2019, as percentage of total intravenous iron released. After exclusion of haemodialysis, where FG is still widely used, the FCM use in the last four years raised from 12.9% to 92.5%. Despite the higher FCM cost, the mean yearly expenditure for intravenous iron plus PRBC units did not differ between pre- and post-FCM eras (2010-2013, € 2,396,876 € versus 2014-2019, € 2,307,875 - p = 0.234), as a result of a net decrease of PRBC usage, namely from 15,083 to 12,654 (-16.1 %), respectively. DISCUSSION: Intravenous iron has a major role in treating iron deficiency anaemia in several settings. Third generation compounds are paving the way to more updated and safer treatments.

Fortification of staple cereal flours with iron and other micronutrients: cost implications of following World Health Organization-endorsed recommendations.

BACKGROUND: Wheat and maize flours are widely used delivery vehicles for mass fortification. In lower-income countries, most, if not all, national-level cereal flour fortification programs routinely fortify with iron; however, cofortification with other micronutrients is common. Little information is available on the cost implications programs face when considering current fortification practices versus what the World Health Organization (WHO) interim consensus statement recommends. OBJECTIVE: The objectives of the present paper are to provide information on the costs of adding different chemical forms of iron and/or other micronutrients to premix formulations, and to discuss some of the issues that should be considered regarding which micronutrients to include in the premix. METHODS: Nine countries in Latin America, Africa, and Asia (three countries per region) that currently cofortify with multiple micronutrients including iron were selected based on low (< 75 g/day), medium (75 to 149 g/day), and high (> or = 150 g/day) mean population flour consumption levels. Premix costs per metric ton of flour produced were estimated for improving iron formulations and for following WHO recommendations for other micronutrients. RESULTS: For the selected programs to maintain current premix formulations and improve iron compounds, premix costs would increase by between 155% and 343% when the iron compound was switched from electrolytic iron to sodium iron ethylenediaminetetraacetate (NaFeEDTA), by 6% to 50% when it was switched from electrolytic iron to ferrous sulfate, and by 4% to 13 when iron addition rates were adjusted without switching the compound. To meet WHO recommendations for other micronutrients, premix costs would increase the most when the amounts of vitamins B12 and A were increased. CONCLUSIONS: For programs that currently cofortify with iron and additional micronutrients, the quality of the iron fortificant should not be overlooked simply to be able to afford to add more micronutrients to the premix. Micronutrients should be selected according to population needs, costs, and potential beneficial synergistic reactions the added micronutrients may have.

Comparison of efficacy, tolerability, and cost of iron polymaltose complex with ferrous sulphate in the treatment of iron deficiency anemia in pregnant women.

BACKGROUND: The efficacy of iron polymaltose complex (IPC) in the treatment of iron deficiency anemia (IDA) during pregnancy has not been well established, and the evidence is inconclusive. AIMS: The aim of the study was to compare efficacy, safety, compliance, and cost-effectiveness of IPC with ferrous sulphate (FS) in pregnant patients. SETTINGS AND DESIGNS: The randomized, double-blind, parallel-group study was conducted in the Department of Pharmacology in collaboration with the Department of Obstetrics and Gynaecology Postgraduate Institute of Medical Education and Research, Chandigarh, India. METHODS: One hundred pregnant women aged 20-40 years at 14 to 27 weeks' gestation, with hemoglobin (Hb) < 9 g/dL, and serum ferritin < 12 mcg/L, were classified into 2 groups. One group received IPC (100 mg elemental iron), and the other group received FS (120 mg elemental iron) daily for 8 weeks. At Week 0 and Week 8, Hb, packed cell volume (PCV), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), serum iron, and serum ferritin were measured. Compliance with study medication was determined by pill counting at each visit. Cost minimization analysis was done to compare the costs of the 2 treatments. STATISTICAL ANALYSIS: Data are expressed as mean -/+ SD. Paired and unpaired 't' test were used to analyze differences within groups and between groups. Chi-square (x2) test was used to analyze primary efficacy parameters and adverse drug reactions (ADR). RESULTS: Statistically significant increases in Hb, PCV, MCV, MCH, MCHC, serum iron, and serum ferritin levels were seen at the end of 8 weeks of treatment in both groups. The overall adverse effects were more common in the FS group compared with the IPC group [41 (78%) vs 15 (31%), P < .001]. The compliance rate was significantly (P < .05) higher for the IPC (91%) group than for the FS (87%) group. The average total cost (direct + indirect) of treatment of anemia was comparable between the 2 groups. CONCLUSION: The results of the present study suggest that IPC can be considered as a useful alternative formulation for the treatment of IDA during pregnancy for those patients who cannot tolerate other iron preparations (ferrous form); this is an important finding, as compliance is a significant concern during pregnancy.

[Treatment of iron deficiency anaemia in pregnant, puerperal and gynaecological patients--different drugs, different approaches].

UNLABELLED: According to WHO about 50 per cent of women of fertile age have iron deficiency anaemia (IDA). Iron loss > 80 mg per month, with menstruation in 22 per cent of women cause a negative iron balance in the course of time. About 40 per cent of women have data of prelatent iron deficiency still before conception, and if the demands of occured pregnancy are added, IDA is quickly reached. Over 30 per cent of puerperal women are affected by anaemia. PURPOSE: To make a pharmacoeconomic assessment of peroral antianaemic drugs used for treatment of IDA in pregnant, puerperal and gynaecologically ill women. MATERIALS: There are presented- daily intake of drugs, number of drug package taken, the price of a drug package, value of treatment a month, reimbursement of the drugs below: Ferro Gradumet, Maltofer Fol, Sorbifer Durules, Tot'hema, Legofer, Ferro-Folgamma, Tardiferon. RESULTS: The survey made and the data of own studies show that the most important in treatment of IDA are the choice of iron- containing drug and the correct therapeutic approach. The choice of peroral iron- containing therapy is determined by: high "patient compliance"--good tolerance, independence on food intake, once daily intake, low frequency of adverse effects and treatment with low price (economic effect). CONCLUSION: The most suitable for treatment of IDA in pregnant and puerperal women are Maltofer Fol and Sorbifer Durules. Maltofer Fol is with the best correlation price: "patient compliance". Tot'hema and Legofer have a good tolerance, a few adverse effects, but they are with high price. Ferro folgamma has not a high "patient compliance" and it has comparatively high price. Ferro gradumet has a low price and low "patient compliance".

Investigation into the non-biological outputs of mechanical-biological treatment facilities.

Mechanical-biological and biological-mechanical treatment (MBT/BMT) are effective methods for reducing biogenic additions to landfill, producing fuel products and recovering recyclate from residual waste. However, large amounts of contamination in the non-biological outputs reduce their market value. The aim of this study was therefore to identify the principal drivers and barriers to the marketability of ferrous metals (MBTFe) and heavy inert rejects (MBTr) recovered from four UK MBT/BMT plants. The plants were either using biodrying or anaerobic digestion (AD-MBT) for biological processing. Samples were collected at the different recovery stage processes and characterised for elemental composition and particle size distribution. Results showed that processes at the two biodrying plants produced MBTFe with 10% less contamination by non-target materials than the two AD-MBT plants. Further to this, approximately 10% of the MBTFe fraction sampled at all four facilities comprised non-target material which had become entrapped in the folds of metal food containers. A possible cause is waste comminution in the cutting gap of the low-speed high-torque cutting mills. Upgrading MBTFe outputs could save the UK MBT/BMT industry up to £ 4.4 million per annum which equates to £ 230,000 per annum for an average sized facility (i.e. capacity 108,000 tpa). Glass content in the MBTr samples ranged between 44% and 62%, however all plants showed approximately 85% combined content of glass, bricks, stones and ceramics. The biodegradable content in the MBTr samples indicated that only minimal upgrade would be required to achieve the Landfill Directive requirements for inert waste. Again valorisation of MBTr could save the UK MBT/BMT industry up to £ 1.9 million pa which equates to £ 160,000 per annum for an average sized facility.