[Use of intravenous iron infusion in a gastroenterology day hospital: Indications, dosage and adverse effects]. / Uso del hierro intravenoso en un hospital de día de aparato digestivo: indicaciones, dosificación y efectos adversos.

UNLABELLED: There are no data in the literature on the use of intravenous iron infusion in gastroenterology day hospitals. OBJECTIVE: To determine the indications, dosage and tolerance of intravenous iron infusion in outpatients attending a gastroenterology day hospital. MATERIAL AND METHODS: We retrospectively reviewed the medical records of patients who received intravenous iron infusion between August 2007 and July 2008. The indications, dosage, transfusion requirements, adverse effects and patients' clinical and laboratory data were recorded. RESULTS: During the study period, 111 patients (41% women, with a mean age of 63.8 ± 18 years) received intravenous iron infusions. The main causes of anemia indicating iron administration were portal hypertensive gastropathy (n=55), inflammatory bowel disease (n=22) and intestinal angiodysplasia (n=12). The patients received a total of 557 iron infusions with a mean dose of 1033 mg iron per patient. There were no adverse effects. Despite the treatment, 46 patients required transfusion. Iron and transfusion requirements and mortality were significantly higher in patients with liver cirrhosis than in the remainder of the study group. CONCLUSION: Intravenous iron therapy is frequently used in the gastroenterology day hospital. Most infusions were administered in patients with chronic iron loss. Patients with liver cirrhosis had the most severe anemia and underlying disease and the highest mortality.

Cost-minimization analysis favours intravenous ferric carboxymaltose over ferric sucrose for the ambulatory treatment of severe iron deficiency.

OBJECTIVE: Intravenous iron is widely used to treat iron deficiency in day-care units. Ferric carboxymaltose (FCM) allows administration of larger iron doses than iron sucrose (IS) in each infusion (1000 mg vs. 200 mg). As FCM reduces the number of infusions required but is more expensive, we performed a cost-minimization analysis to compare the cost impact of the two drugs. MATERIALS AND METHODS: The number of infusions and the iron dose of 111 consecutive patients who received intravenous iron at a gastrointestinal diseases day-care unit from 8/2007 to 7/2008 were retrospectively obtained. Costs of intravenous iron drugs were obtained from the Spanish regulatory agencies. The accounting department of the Hospital determined hospital direct and indirect costs for outpatient iron infusion. Non-hospital direct costs were calculated on the basis of patient interviews. In the pharmacoeconomic model, base case mean costs per patient were calculated for administering 1000 mg of iron per infusion using FCM or 200 mg using IS. Sensitivity analysis and Monte Carlo simulation were performed. RESULTS: Under baseline assumptions, the estimated cost of iron infusion per patient and year was €304 for IS and €274 for FCM, a difference of €30 in favour of FCM. Adding non-hospital direct costs to the model increased the difference to €67 (€354 for IS vs. €287 for FCM). A Monte Carlo simulation taking into account non-hospital direct costs favoured the use of FCM in 97% of simulations. CONCLUSION: In this pharmacoeconomic analysis, FCM infusion reduced the costs of iron infusion at a gastrointestinal day-care unit.

Uso del hierro intravenoso en un hospital de día de aparato digestivo: indicaciones, dosificación y efectos adversos / Use of intravenous iron infusion in a gastroenterology day hospital: Indications, dosage and adverse effects

ResumenNo hay datos en la literatura médica respecto del uso del hierro (Fe) intravenoso en los hospitales de día de aparato digestivo.ObjetivoDeterminar las indicaciones, la dosificación y la tolerancia del Fe intravenoso en los pacientes ambulatorios atendidos en un hospital de día de digestivo.Material y métodosSe revisaron retrospectivamente las historias clínicas de los pacientes que habían recibido Fe intravenoso en el período comprendido entre agosto de 2007 y julio de 2008. Se recogieron las indicaciones, la dosificación, los requerimientos de transfusión, los efectos adversos y la evolución clinicoanalítica de los pacientes.ResultadosDurante el período de estudio 111 pacientes (el 41% eran mujeres, con edad media de 63,8±18 años) recibieron Fe intravenoso. Las principales causas de anemia para la administración de Fe intravenoso fueron gastropatía por hipertensión portal (n=55), enfermedad inflamatoria intestinal (n=22) y angiodisplasia intestinal (n=12). Los pacientes recibieron un total de 557 infusiones de Fe, con una dosis media de 1.033mg de Fe por paciente. La infusión de Fe no presentó efectos secundarios. A pesar del tratamiento, 46 pacientes necesitaron transfusión. Los pacientes con cirrosis hepática presentaron un requerimiento de Fe, transfusión y una mortalidad significativamente mayores que el resto del grupo de estudio.ConclusiónEl Fe intravenoso se utiliza muy a menudo en el hospital de día de digestivo. La mayor parte de las infusiones se realizan a pacientes con pérdidas crónicas y los pacientes con cirrosis hepática son los que presentan una anemia más marcada, una enfermedad de base más grave y una mayor mortalidad (AU)

AbstractThere are no data in the literature on the use of intravenous iron infusion in gastroenterology day hospitals.ObjectiveTo determine the indications, dosage and tolerance of intravenous iron infusion in outpatients attending a gastroenterology day hospital.Material and methodsWe retrospectively reviewed the medical records of patients who received intravenous iron infusion between August 2007 and July 2008. The indications, dosage, transfusion requirements, adverse effects and patients’ clinical and laboratory data were recorded.ResultsDuring the study period, 111 patients (41% women, with a mean age of 63.8±18 years) received intravenous iron infusions. The main causes of anemia indicating iron administration were portal hypertensive gastropathy (n=55), inflammatory bowel disease (n=22) and intestinal angiodysplasia (n=12). The patients received a total of 557 iron infusions with a mean dose of 1033mg iron per patient. There were no adverse effects. Despite the treatment, 46 patients required transfusion. Iron and transfusion requirements and mortality were significantly higher in patients with liver cirrhosis than in the remainder of the study group.ConclusionIntravenous iron therapy is frequently used in the gastroenterology day hospital. Most infusions were administered in patients with chronic iron loss. Patients with liver cirrhosis had the most severe anemia and underlying disease and the highest mortality (AU)