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

Vollständiger Abstract

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Heart failure with reduced ejection fraction (HFrEF) poses a significant clinical and economic burden in Malaysia, particularly in Perak. Iron deficiency (ID) in HFrEF is associated with increased hospitalization risk. While international guidelines recommend intravenous ferric derisomaltose (FDI), its economic viability within Perak’s public hospitals remains undefined. This study estimated the 3-year budget impact of introducing FDI therapy for HFrEF patients with ID in Perak public hospitals from the Malaysian Ministry of Health perspective. An Excel-based budget impact model compared a “World-with-FDI” scenario against the current standard of care (no intravenous iron) over a 3-year horizon (2026–2028). The eligible cohort was estimated using demographic projections, regional prevalence registries (Asian-heart failure [HF], MY-HF), and public sector utilization rates. Clinical efficacy (rate ratio of hospitalization) and dosing parameters were derived from the IRONMAN trial, incorporating drug acquisition and hospitalization costs. Deterministic one-way sensitivity analyses tested parameter uncertainties. Phased introduction of FDI required negligible investment of RM 2686 in Year 1. During maintenance dosing, savings from reduced hospitalizations significantly outweighed drug acquisition costs, generating net savings of RM 442,279 in Year 2 and RM 889,529 in Year 3. The 3-year cumulative savings totaled RM 1.33 million. Sensitivity analyses revealed the model is highly sensitive to hospitalization costs; prioritizing high-risk patients amplified Year 3 savings to over RM 2 million, while low-cost, stable cohorts resulted in a net budget deficit. FDI is cost-saving for managing HFrEF with ID in Perak. Strategic patient selection targeting high-utilization cohorts maximizes financial sustainability, while single-visit dosing offers operational efficiencies.