Intravenous Iron Therapy in an Outpatient Setting in North-East Italy: A Pharmacoeconomic and Patient Blood Management Perspective

Background: Iron deficiency anaemia is a major public health problem. Oral iron is generally recommended as first-line treatment because it is inexpensive and easily administered, but its use may be limited by gastrointestinal adverse effects, poor adherence, or inadequate absorption. Intravenous (IV) iron is an effective alternative when oral treatment is ineffective or poorly tolerated, or when rapid iron repletion is required. High-dose IV iron formulations may reduce the number of outpatient visits required to complete treatment. Materials and Methods: We retrospectively evaluated patients receiving IV iron therapy in seven outpatient clinics managed by the Department of Transfusion Medicine of the Province of Venice (North-East Italy) between January 2020 and December 2025. Ferric carboxymaltose (FCM) 100 mg and 500 mg and ferric derisomaltose (FDI) 1000 mg were used. An Activity-Based Costing (ABC) analysis was performed considering the cost of the iron preparation, the number of IV administrations and the associated healthcare and estimated non-healthcare costs required to complete a treatment cycle. A separate Patient Blood Management (PBM) analysis estimated the number of red blood cell (RBC) units and associated costs that would have been required under a predefined hypothetical transfusion scenario. Results: During the study period, 29,614 IV iron administrations were recorded in 13,683 patients. The mean number of administrations required to complete a treatment cycle was 9.1 with FCM 100 mg, 1.9 with FCM 500 mg and 1.1 with FDI 1000 mg, corresponding to approximately 79% and 88% reductions in outpatient visits compared with FCM 100 mg, respectively. The mean cost per treatment cycle was €1820.91 for FCM 100 mg, €444.79 for FCM 500 mg and €342.21 for FDI 1000 mg. Under the predefined hypothetical transfusion scenario, 5149 RBC units would have been required for patients with haemoglobin concentrations of <80 g/L or 81–90 g/L, corresponding to an estimated cost of €2,067,323.50. No RBC transfusions were recorded in the available Department of Transfusion Medicine of the District of Venice (DIMT) outpatient database during the study period. Conclusions: In this real-world outpatient network, the use of high-dose IV iron formulations was associated with substantially fewer outpatient visits and lower estimated treatment-cycle costs than low-dose FCM. The reduction in the number of administrations may also increase outpatient treatment capacity and facilitate the management of iron deficiency within a PBM-oriented model. The estimated RBC requirements and associated costs should be interpreted as a hypothetical scenario rather than as observed transfusion avoidance or realised cost savings.