Perspectives on Intravenous Iron Therapy Logistics and Adherence: Results from a Patient Survey

Purpose: Iron deficiency anemia (IDA) affects approximately 5 million people in the United States (US), significantly impacting quality of life (QoL) and overall health. Iron stores can be replenished through oral iron or, if ineffective/poorly tolerated, through intravenous iron (IVI) therapy. Despite IVI effectiveness, patients do delay/miss infusion appointments, leading to incomplete treatment response. Here we evaluated multiple-dose IVI therapy logistics and adherence from the patient perspective. Patients and Methods: US adult patients (≥ 18 years) with confirmed IDA who were currently prescribed an IVI treatment course were asked to respond to a 46-question online survey in early 2023. Questions covered patient demographics, appointment logistics, IVI infusion experience, impact of infusion on daily activities, reason(s) for missing any doses, and considerations for improving adherence. Results: A total of 323 patients completed the survey, 193 of whom were prescribed ≥ 2 IVI infusions per month. Of these patients, 71/193 (36.8%) reported missing at least one dose, despite its effectiveness at improving symptoms. Most patients (122/193 [64.3%]) agreed that multiple-dose IVI therapy adversely impacted their QoL by reducing their productivity (63.4%) and attendance at important events (64.8%), with 80.3% reporting having to schedule their life around therapy. A third of patients (73/193 [38.1%]) were unsatisfied with their infusion frequency, with most (163/193 [84.5%]) agreeing that fewer IVI infusions would improve adherence, and most also (174/193 [90.1%]) preferring a single-dose option if available. Conclusion: Time spent arranging and receiving multiple IVI infusions per month can interfere with patients’ daily activities, leaving them dissatisfied with their IVI treatment experience. In this study, single-dose IVI infusions were a preferred option for patients with IDA, which may improve adherence to the complete course of treatment and offer improved QoL. Therefore, patient preference, convenience, and satisfaction should be considered and discussed when determining the type of IVI treatment. Plain Language Summary: Iron deficiency anemia (IDA) is a prevalent health condition where the body does not have enough iron to, among other things, make enough red blood cells, which are needed for carrying oxygen around the body. One way to treat IDA is by delivering iron directly into the bloodstream, which is known as an intravenous iron (IVI) infusion. However, there are insurance plans that require patients to try multi-dose IVI treatments before covering treatments that can be given as a single dose. Some patients with IDA delay or miss their IVI appointments, the latter of which can impact treatment efficacy. To better understand why some patients delay or miss their IVI appointments, a survey asked patients with IDA about their IVI infusion experiences. A total of 323 patients completed the survey, with 193 receiving at least two IVI infusions per month. Most patients agreed that having several monthly IVI infusions per treatment course negatively affected their daily lives by reducing their productivity and causing them to miss important events. A majority also agreed they had to plan their lives around treatment. Among the 71 patients who missed appointments, most agreed that fewer monthly infusions would make it easier to complete the full treatment course and nearly all would prefer a single dose option if available. These results suggest multiple IVI infusions can negatively affect patients’ lives and their commitment to treatment. Therefore, it is important to consider patient convenience and insurance coverage when planning IVI treatment, as single IVI infusions may be more appealing for patients. Patients’ views on this issue are relevant, as their willingness to commit to best treatment practices is key to successful care.