Management of Iron Overload in Chronic Blood Transfusion by Chelation Therapy: A Cost Utilization Analysis

Abstract

The financial burden of caring chelation therapy in iron overload is an emerging medical problem in developing countries.  The objective of this study was to compare the cost of different mode of treatment of chelation therapy in the management of iron overload with chronic blood transfusion. The study was conducted in a tertiary care hospital. Thirty seven subjects having received more than 20 blood transfusions and serum ferritin greater than 1500 ng/ml were enrolled and randomized into three groups. Group-I received Desferrioxamine (DFX) at a dose of 40 mg/kg/day, 5 days/week. Group-II received Deferiprone (L₁) at a dose of 75 mg/kg daily. Group-III received a combination of DFX at a dose of 2 days/week and L₁ daily. The subjects were followed up for a period of six months. The comparison of the anthropometric data showed no statistical difference between the groups. The health care utilization was more in group-I as compared with other two groups. The descriptive annualized cost difference of group-I and group-III with group–II as minimum were 77.13 and 38.03 thousand (`) respectively. The patients treated with DFX therapy were having more incidences of hospitalization and poor compliance which leads to increased cost of the health care utilization and treatment. The cost utilization was minimum in patients with L₁ chelation therapy, but the patients with uncontrolled serum ferritin and poor compliance may be treated with combination therapy of DFX and L₁ which is cost effective and economical.