Affiliations: [a] Academic Department of Geriatric Medicine, Cardiff University, University Hospital Llandough, Penarth, UK | [b] Department of Integrated Medicine, University Hospital Llandough, Penarth, UK | [c] Academic Department of Nephrology, University Hospital of Wales, Heath Park, Cardiff, UK | [d] Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff, UK | [e] Centre for Health Information, Researfch And evaLuation (CHIRAL), Medical School, Swansea University, Swansea, UK
Correspondence:
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Address for correspondence: Dr. Victor Man-Fai Sim, Consultant Physician in General and Geriatric Medicine, Academic Department of Geriatric Medicine, University Hospital Llandough, Penlan Road, Penarth, Vale of Glamorgan CF64 2XX, Wales, UK. Tel.: +44 29 2071 1711; Fax: +44 29 2071 5009; E-mail: Victor.Sim@cardiffandvale.wales.nhs.uk.
Abstract: Studies suggest benefits from correcting anaemia in heart failure using a combination of erythropoiesis-stimulating agents (ESAs) and intravenous iron. We set out to investigate the number of older patients who would require treatment of anaemia in a large teaching hospital in the United Kingdom and the cost implications. The prevalence of anaemia and chronic kidney disease (CKD) in patients 65 years and older with systolic dysfunction attending the local heart failure clinic was determined. The projected numbers of patients in our health district who would meet published kidney disease guidelines for treatment of anaemia was then estimated. The costs of treatment with combination ESAs and IV iron were calculated for these patients based on the treatment costs for renal anaemia in our local renal unit. Sensitivity analysis for different thresholds of haemoglobin and eGFR was performed. In our study of 86 heart failure patients, mean age 81 years, 34% have anaemia and 73% have stage III CKD with estimated glomerular filtration rate < 60 ml/min/1.73 cm2. At the haemoglobin threshold value of ≤ 11.0 g/dl for treatment of anaemia in heart failure patients with stage III CKD, 1031 elderly heart failure patients in our health district (total population 424,654) would require treatment with IV iron and erythropoietin, at a cost of £2.7 million per annum. The estimated cost of treating anaemia in elderly patients with heart failure using ESAs and IV iron is substantial and its cost effectiveness is unknown.
