{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T21:02:15Z","timestamp":1791925335060,"version":"4.3.4"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2021,6,30]],"date-time":"2021-06-30T00:00:00Z","timestamp":1625011200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006484","name":"Vifor Pharma","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006484","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European J of Heart Fail"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Iron deficiency is common in patients with heart failure (HF). In AFFIRM\u2010AHF, ferric carboxymaltose (FCM) reduced the risk of hospitalisations for HF (HHF) and improved quality of life vs. placebo in iron\u2010deficient patients with a recent episode of acute HF. The objective of this study was to estimate the cost\u2010effectiveness of FCM compared with placebo in iron\u2010deficient patients with left ventricular ejection fraction &lt;50%, stabilised after an episode of acute HF, using data from the AFFIRM\u2010AHF trial from Italian, UK, US and Swiss payer perspectives.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>\n                      A lifetime Markov model was built to characterise outcomes in patients according to the AFFIRM\u2010AHF trial. Health states were defined using the 12\u2010item Kansas City Cardiomyopathy Questionnaire (KCCQ\u201012). Subsequent HHF were incorporated using a negative binomial regression model with cardiovascular and all\u2010cause mortality incorporated via parametric survival analysis. Direct healthcare costs (2020 GBP\/USD\/EUR\/CHF) and utility values were sourced from published literature and AFFIRM\u2010AHF. Modelled outcomes indicated that treatment with FCM was dominant (cost saving with additional health gains) in the UK, USA and Switzerland, and highly cost\u2010effective in Italy [incremental cost\u2010effectiveness ratio (ICER) EUR 1269 per quality\u2010adjusted life\u2010year (QALY)]. Results were driven by reduced costs for HHF events combined with QALY gains of 0.43\u20130.44, attributable to increased time in higher KCCQ states (representing better functional outcomes). Sensitivity and subgroup analyses demonstrated data robustness, with the ICER remaining dominant or highly cost\u2010effective under a wide range of scenarios, including increasing treatment costs and various patient subgroups, despite a moderate increase in costs for\n                      <jats:italic>de novo<\/jats:italic>\n                      HF and smaller QALY gains for ischaemic aetiology.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Ferric carboxymaltose is estimated to be a highly cost\u2010effective treatment across countries (Italy, UK, USA and Switzerland) representing different healthcare systems.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejhf.2270","type":"journal-article","created":{"date-parts":[[2021,7,1]],"date-time":"2021-07-01T04:00:03Z","timestamp":1625112003000},"page":"1687-1697","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Ferric carboxymaltose for the treatment of iron deficiency in heart failure: a multinational cost\u2010effectiveness analysis utilising\n                    <scp>AFFIRM\u2010AHF<\/scp>"],"prefix":"10.1093","volume":"23","author":[{"given":"Phil","family":"McEwan","sequence":"first","affiliation":[{"name":"Health Economics and Outcomes Research Ltd  Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piotr","family":"Ponikowski","sequence":"additional","affiliation":[{"name":"Department of Heart Diseases Wroc\u0142aw Medical University  Wroc\u0142aw Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason A.","family":"Davis","sequence":"additional","affiliation":[{"name":"Health Economics and Outcomes Research Ltd  Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Rosano","sequence":"additional","affiliation":[{"name":"Cardiovascular and Cell Sciences Research Institute St George's University  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.S.","family":"Coats","sequence":"additional","affiliation":[{"name":"University of Warwick  Warwick UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Dorigotti","sequence":"additional","affiliation":[{"name":"Vifor Pharma  Glattbrugg Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donal","family":"O'Sullivan","sequence":"additional","affiliation":[{"name":"Vifor Pharma  Glattbrugg Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Ramirez de Arellano","sequence":"additional","affiliation":[{"name":"Vifor Pharma  Glattbrugg Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ewa A.","family":"Jankowska","sequence":"additional","affiliation":[{"name":"Department of Heart Diseases Wroc\u0142aw Medical University  Wroc\u0142aw Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,6,30]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.1858"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/heart.87.3.235"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10741-019-09890-2"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.11.053"},{"key":"e_1_2_8_6_1","first-page":"846","article-title":"A cost\u2010effectiveness analysis of ferric carboxymaltose in patients with iron deficiency and chronic heart failure in Spain","volume":"68","author":"Com\u00edn\u2010Colet J","year":"2015","journal-title":"Rev Esp Cardiol"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000757"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.118.030099"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehs224"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.139"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2003.04.073"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/00015385.2017.1351239"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)32339-4"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.027497"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.1710"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.115.001958"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.1978"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X13497998"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2011.05.007"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.2217\/cer-2019-0074"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2016-310661"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-012-2072-y"},{"key":"e_1_2_8_23_1","first-page":"w14533","article-title":"Cost\u2010effectiveness of sacubitril\/valsartan in chronic heart\u2010failure patients with reduced ejection fraction","volume":"147","author":"Ademi Z","year":"2017","journal-title":"Swiss Med Wkly"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.919"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1409077"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.09.542"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-020-01781-w"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurjhf\/hfs083"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.3111\/13696998.2015.1029491"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1002\/ehf2.12432"}],"container-title":["European Journal of Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ejhf.2270","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ejhf.2270","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ejhf.2270","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T12:15:01Z","timestamp":1767701701000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ejhf.2270"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,30]]},"references-count":29,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2021,10]]}},"alternative-id":["10.1002\/ejhf.2270"],"URL":"https:\/\/doi.org\/10.1002\/ejhf.2270","archive":["Portico"],"relation":{},"ISSN":["1388-9842","1879-0844"],"issn-type":[{"value":"1388-9842","type":"print"},{"value":"1879-0844","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,30]]},"assertion":[{"value":"2021-05-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-06-12","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-06-30","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}