Therasse C (1), Bocquet (1) (2), Fusier I (1), Cordonnier AL (1), Sinègre M (1)
(1) General Agency of Equipment and Health Products (AGEPS), AP-HP, Paris, France
(2) Paris Dauphine University, Paris, France.
Objectives
To assess the global economic consequences for French hospitals of the European Commission (EC) decision to strengthen administration conditions of intravenous iron products (IIP) (iron sucrose (IS) and ferric carboxymaltose (FC)) due to safety concerns. Following this EC decision, in February 2014, French Health Authorities decided to give a hospital-restricted status (HRS) to IIP.
Methods
We compared, in acute care (medicine,-surgery-obstetrics) hospitals, IIP consumption and expenditure (extracted from SAP software) before (2012 vs. 2013) and before-after (02/2013-04/2013 vs. 02/2014-04/2014) they had a HRS, and the number of diagnosis-related group “sessions of chemotherapy for non-tumor disease” (DRG-CNTD) linked to anemia (Technical Agency of Information on Hospitals data).
Results
20 hospitals were included. Before they had a HRS, IIP global consumption in volume increased by 9.6% (i.e. €171,022 spent more) in a year. After IIP had a HRS, the increase was 16.7% (i.e. €164,338 spent more) in 3 months (02/2013-04/2013 vs. 02/2014-04/2014). 23.7% of the increase was attributable to day hospital admissions (DHA) and 4.4% to dialysis units. FC consumption was 23.9% higher (i.e. €188,838 spent more) in 2014 compared to 2013, whereas IS consumption was 16.4% lower (i.e. €24,500 spent less). DHA in DRG-CNTD linked to anemia increased by a factor of 1.8 .
Conclusions
DHA as part of the DRG-CNTD is the only way to finance this additional hospital activity (no additional funding for traditional hospital care). FC’s cost of daily treatment (€120 to €150) is about 20 times IS’s (€5.2 to €7.8), while a single tariff is allocated for the DRG-CNTD (drug case-mix: €62, whatever the drug). Costs of the FC increasing use to manage anemia may be offset by administration of other drugs, or the DRG-tariff should be adjusted. Another alternative would be to implement a tender between IIP, taking into account the cost-effective ratio of each drug.