From the 2024 HVPA National Conference
Ellen Yin PharmD (University of Texas Medical Branch), Gaurav Goyal PharmD, Nathan Vo RPH, MBA, Bagi Jana MD, Maryam Bayat PharmD
Background:
Iron deficiency in the United States affects approximately 10 million individuals, including 5 million affected by iron deficiency anemia. This underscores the need for safe, convenient, and effective treatment modalities. Clinically, all formulations of intravenous (IV) iron are equally efficacious. The major difference among the various formulations lay in the infusion time and dose per visit. In this regard, there are certain formulations of IV iron collectively known as high-dose IV iron, which include ferumoxytol, ferric carboxymaltose, ferric derisomaltose, and iron dextran that are preferable in outpatient settings due to their inherent advantages in patient care delivery.
Objective:
To assess the impact of interventions favoring high-dose IV iron products on patient safety, operations, and reimbursement.
Methods:
A retrospective analysis spanning six months pre- and post-intervention was performed to evaluate the impact of initiatives aimed at increasing the utilization of high-dose IV iron products. These interventions comprised of provider education, regular multidisciplinary meetings to refine infusion scheduling practices, and the introduction of a smart phrase advocating on the preference for ferric derisomaltose, with iron dextran as secondary if insurance approval could not be secured. Of note, as an organization that has adopted EPIC as our electronic medical record of choice, Clinical Decision Support in the form of Therapy Plans or Supportive Care Treatment Plans remains unavailable for use in the outpatient, non-oncology, setting.
Results:
Use of high-dose IV iron agents increased post-intervention from 39% to 61% (p < 0.01) with a decrease in the use of iron sucrose and an increase in the use of ferric derisomaltose and iron dextran. Baseline characteristics appeared similar across groups including payor type. Total chair time decreased by 178 hours (p < 0.01) while the amount of IV iron given remained similar (358 g pre-intervention vs 359 g post-intervention). Average infusion time per encounter decreased with an increase in average iron administered per encounter (542 mg pre-intervention vs 704 mg post-intervention; p < 0.01). Iron dextran required the highest amount of chair time and infusion time; however, larger amounts of iron could be given compared to iron sucrose and sodium ferric gluconate. Post-intervention, patients required less visits to the clinic (81% vs 68% required only one visit; p < 0.01) which likely could potentially lead to greater patient satisfaction. Patient safety events were reported 0.6% of the time, all of which were associated with high-dose iron products. Average reimbursement rates were also higher in the post-intervention arm.
Conclusions:
Interventions designed to encourage the preferential adoption of high-dose IV iron products in the outpatient setting have had a significant impact. These include decreased infusion times and enhanced iron dosages administered per visit, potentially leading to improved patient satisfaction and more efficient utilization of healthcare resources. Moreover, a discernible increase in average reimbursement rates has been observed with the prioritized utilization of high-dose IV iron products, underscoring potential financial advantages associated with these strategic interventions.
Clinical Implications:
Use of high-dose IV iron products are preferred in the outpatient infusion setting. Interventions targeted at multi-disciplinary education are effective in driving changes in utilization. A deeper impact is to be expected if one can leverage EPIC Clinical Decision Support – Therapy Plans and Supportive Care Treatment Plans to further drive this strategy.