Open Access Journal Article

A cost-comparative analysis of intravenous Ferric Carboxymaltose versus Iron Sucrose for the ambulatory treatment of Iron-deficiency Anemia in a major tertiary care hospital in Saudi Arabia

by S Alzahrani 1 M Almeziny `,* A Narang 2 O Mohamed 3 Salem Almeziny 4  and  Abdullah Almeziny 5
Prince Sultan Military Medical City, Riyadh, Saudi Arabia
IQVIA, Gurgaon, India
IQVIA, Dubai, DU, United Arab Emirates
College of medicine, Almaarefa University, Riyadh, Saudi Arabia
College of medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
Author to whom correspondence should be addressed.
IJCMR  2023, 5; 1(1), 5;
Received: 19 July 2023 / Accepted: 19 August 2023 / Published Online: 20 August 2023


Background: The objective of this study was to compare the cost of outpatient ferric carboxymaltose (FCM; Ferinject®) versus Iron sucrose complex (ISC; Ferosac®), two prevalent intravenous iron therapy used in the treatment of iron-deficiency anemia (IDA) in the Kingdom of Saudi Arabia (KSA) from a tertiary care hospital perspective.

Methods: A retrospective study was performed for all patients who were administered FCM in the outpatient clinical setting at Prince Sultan Military Medical City from January 1, 2019, until December 31, 2019. The descriptive data was analyzed using Microsoft Excel 2019 (Microsoft Corporation, Redmond, WA, USA). The total cost of treatment reflected the cost of drugs, the cost of disposables for each infusion, drug monitoring costs during infusion, the cost of productivity loss, and patient traveling cost.

Result: Overall, 993 patients with IDA, treated with FCM in 1,688 outpatient visits were recruited in the study. In the outpatient setting, the per annum cost of treatment was SAR 1,434,092.50 with FCM treatment and SAR 1,715,299.70 with ISC treatment, with a corresponding saving of 16.4% (SAR 281,207.20) with FCM. The cost savings with FCM treatment can be attributed to the reduced frequency of patient visits and corresponding reduction in drug monitoring costs (SAR 266,995.20;77.3%), loss of productivity per year (SAR 163,550.20; 77.3%), and cost of transportation per year (SAR 573,920.00; 77.3%).

Conclusion: The use of FCM, as opposed to ISC resulted in a reduced number of iron infusions (4.4 visits for ISC as compared to one visit for FCM), accompanied by a reduction in the total cost. FCM may represent a cost-saving option compared with the existing alternative therapy used for the management of IDA in KSA.

Copyright: © 2023 by Alzahrani, Almeziny, Narang, Mohamed, Almeziny and Almeziny. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (Creative Commons Attribution 4.0 International License). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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ACS Style
Alzahrani, S.; Almeziny, M.; Narang, A.; Mohamed, O.; Almeziny, S.; Almeziny, A. A cost-comparative analysis of intravenous Ferric Carboxymaltose versus Iron Sucrose for the ambulatory treatment of Iron-deficiency Anemia in a major tertiary care hospital in Saudi Arabia. International Journal of Clinical Medical Research, 2023, 1, 5.
AMA Style
Alzahrani S, Almeziny M, Narang A, Mohamed O, Almeziny S, Almeziny A. A cost-comparative analysis of intravenous Ferric Carboxymaltose versus Iron Sucrose for the ambulatory treatment of Iron-deficiency Anemia in a major tertiary care hospital in Saudi Arabia. International Journal of Clinical Medical Research; 2023, 1(1):5.
Chicago/Turabian Style
Alzahrani, S; Almeziny, M; Narang, A; Mohamed, O; Almeziny, Salem; Almeziny, Abdullah 2023. "A cost-comparative analysis of intravenous Ferric Carboxymaltose versus Iron Sucrose for the ambulatory treatment of Iron-deficiency Anemia in a major tertiary care hospital in Saudi Arabia" International Journal of Clinical Medical Research 1, no.1:5.

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  1. Kassebaum NJ, Jasrasaria R, Naghavi M, et al. A systematic analysis of global anemia burden from 1990 to 2010. Blood. 2014;123(5):615-624. doi: 10.1182/blood-2013-06-508325. PubMed PMID: 24297872;
  2. Kassebaum NJ. The Global Burden of Anemia. Hematology/Oncology Clinics of North America. 2016 2016/04/01/;30(2):247-308. doi:
  3. Chaparro CM, Suchdev PS. Anemia epidemiology, pathophysiology, and etiology in low- and middle-income countries. Annals of the New York Academy of Sciences. 2019 Aug;1450(1):15-31. doi: 10.1111/nyas.14092. PubMed PMID: 31008520; PubMed Central PMCID PMCPMC6697587
  4. Mantadakis E, Chatzimichael E, Zikidou P. Iron Deficiency Anemia in Children Residing in High and Low-Income Countries: Risk Factors, Prevention, Diagnosis and Therapy. Mediterr J Hematol Infect Dis. 2020;12(1):e2020041-e2020041. doi: 10.4084/MJHID.2020.041. PubMed PMID: 32670519;
  5. Al Hassan NN. The prevalence of iron deficiency anemia in a Saudi University female students. J Microsc Ultrastruct. 2015 Jan-Mar;3(1):25-28. doi: 10.1016/j.jmau.2014.11.003. PubMed PMID: 30023178;
  6. Owaidah T, Al-Numair N, Al-Suliman A, et al. Iron Deficiency and Iron Deficiency Anemia Are Common Epidemiological Conditions in Saudi Arabia: Report of the National Epidemiological Survey. Anemia. 2020 2020/12/29;2020:6642568. doi: 10.1155/2020/6642568.
  7. Verster A, Vander Pols, Jolieke C. Anaemia in the Eastern Mediterranean Region. 1995 1995.
  8. Goddard AF, James MW, McIntyre AS, et al. Guidelines for the management of iron deficiency anaemia. Gut. 2011;60(10):1309. doi: 10.1136/gut.2010.228874.
  9. Means RT. Iron Deficiency and Iron Deficiency Anemia: Implications and Impact in Pregnancy, Fetal Development, and Early Childhood Parameters. Nutrients. 2020 Feb 11;12(2). doi: 10.3390/nu12020447. PubMed PMID: 32053933; PubMed Central PMCID PMCPMC7071168
  10. Wang M. Iron Deficiency and Other Types of Anemia in Infants and Children. American family physician. 2016 Feb 15;93(4):270-8. PubMed PMID: 26926814;
  11. DeLoughery TG. Iron Deficiency Anemia. The Medical clinics of North America. 2017 Mar;101(2):319-332. doi: 10.1016/j.mcna.2016.09.004. PubMed PMID: 28189173;
  12. WHO. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and mineral nutrition information system; World Health Organization Geneva, Switzerland2011. Available from:
  13. Ko CW, Siddique SM, Patel A, et al. AGA Clinical Practice Guidelines on the Gastrointestinal Evaluation of Iron Deficiency Anemia. Gastroenterology. 2020;159(3):1085-1094. doi: 10.1053/j.gastro.2020.06.046.
  14. WHO. Serum ferritin concentrations for the assessment of iron status and iron deficiency in populations; World Health Organization Geneva, Switzerland2011. Available from:
  15. Daru J, Colman K, Stanworth SJ, et al. Serum ferritin as an indicator of iron status: what do we need to know? Am J Clin Nutr. 2017;106(Suppl 6):1634S-1639S. doi: 10.3945/ajcn.117.155960. PubMed PMID: 29070560;
  16. Pasricha SR, Tye-Din J, Muckenthaler MU, et al. Iron deficiency. Lancet (London, England). 2021 Jan 16;397(10270):233-248. doi: 10.1016/s0140-6736(20)32594-0. PubMed PMID: 33285139;
  17. Aleem A, Alsayegh F, Keshav S, et al. Consensus Statement by an Expert Panel on the Diagnosis and Management of Iron Deficiency Anemia in the Gulf Cooperation Council Countries. Medical Principles and Practice. 2020;29(4):371-381. doi: 10.1159/000503707.
  18. Goddard AF, James MW, McIntyre AS, et al. Guidelines for the management of iron deficiency anaemia. 2011;60(10):1309-1316. doi: 10.1136/gut.2010.228874 %J Gut.
  19. Johnson-Wimbley TD, Graham DY. Diagnosis and management of iron deficiency anemia in the 21st century. Therap Adv Gastroenterol. 2011;4(3):177-184. doi: 10.1177/1756283X11398736. PubMed PMID: 21694802;
  20. Trumbo H, Kaluza K, Numan S, et al. Frequency and Associated Costs of Anaphylaxis- and Hypersensitivity-Related Adverse Events for Intravenous Iron Products in the USA: An Analysis Using the US Food and Drug Administration Adverse Event Reporting System. Drug safety. 2021 Jan;44(1):107-119. doi: 10.1007/s40264-020-01022-2. PubMed PMID: 33237523; PubMed Central PMCID PMCPMC7813702 Lawrence T. Goodnough is a consultant for American Regent. Karolina Kaluza and Syed Numan are employees of American R
  21. Wang C, Graham DJ, Kane RC, et al. Comparative Risk of Anaphylactic Reactions Associated With Intravenous Iron Products. Jama. 2015 Nov 17;314(19):2062-8. doi: 10.1001/jama.2015.15572. PubMed PMID: 26575062;
  22. Fishbane S, Kowalski EA. The comparative safety of intravenous iron dextran, iron saccharate, and sodium ferric gluconate. Seminars in dialysis. 2000 Nov-Dec;13(6):381-4. doi: 10.1046/j.1525-139x.2000.00104.x. PubMed PMID: 11130261;
  23. USFDA. MONOFERRIC (ferric derisomaltose) injection, for intravenous use; Prescribing information 2020. Available from:
  24. Aleem A, Alsayegh F, Keshav S, et al. Consensus Statement by an Expert Panel on the Diagnosis and Management of Iron Deficiency Anemia in the Gulf Cooperation Council Countries. Medical principles and practice : international journal of the Kuwait University, Health Science Centre. 2020;29(4):371-381. doi: 10.1159/000503707. PubMed PMID: 31698356; PubMed Central PMCID PMCPMC7445696
  25. Vifor. Prescribing Information; Venofer (iron sucrose) injection 200 [updated 2017;June 15, 2021]. Available from:
  26. Aronoff GR, Bennett WM, Blumenthal S, et al. Iron sucrose in hemodialysis patients: safety of replacement and maintenance regimens. Kidney international. 2004 Sep;66(3):1193-8. doi: 10.1111/j.1523-1755.2004.00872.x. PubMed PMID: 15327417;
  27. Charytan C, Schwenk MH, Al-Saloum MM, et al. Safety of iron sucrose in hemodialysis patients intolerant to other parenteral iron products. Nephron Clinical practice. 2004;96(2):c63-6. doi: 10.1159/000076401. PubMed PMID: 14988600;
  28. Vifor. INJECTAFER® (ferric carboxymaltose injection); Food and Drug Administration 2013. Available from:
  29. Covic A, Mircescu G. The safety and efficacy of intravenous ferric carboxymaltose in anaemic patients undergoing haemodialysis: a multi-centre, open-label, clinical study. Nephrol Dial Transplant. 2010;25(8):2722-2730. doi: 10.1093/ndt/gfq069. PubMed PMID: 20190247;
  30. Kulnigg S, Stoinov S, Simanenkov V, et al. A novel intravenous iron formulation for treatment of anemia in inflammatory bowel disease: the ferric carboxymaltose (FERINJECT) randomized controlled trial. The American journal of gastroenterology. 2008 May;103(5):1182-92. doi: 10.1111/j.1572-0241.2007.01744.x. PubMed PMID: 18371137;
  31. Rognoni C, Venturini S, Meregaglia M, et al. Efficacy and Safety of Ferric Carboxymaltose and Other Formulations in Iron-Deficient Patients: A Systematic Review and Network Meta-analysis of Randomised Controlled Trials. Clinical drug investigation. 2016 Mar;36(3):177-94. doi: 10.1007/s40261-015-0361-z. PubMed PMID: 26692005; PubMed Central PMCID PMCPMC4761015
  32. Al-Shaghana M, Brooke E, Sinha A, et al. Efficacy and cost effectiveness of ferric carboxymaltose (Ferinject) in the treatment of pregnant women with iron deficiency anaemia. European Journal of Obstetrics and Gynecology and Reproductive Biology. 2016;206:e6. doi: 10.1016/j.ejogrb.2016.07.046.
  33. Hofmarcher T, Borg S. Cost-effectiveness analysis of ferric carboxymaltose in iron-deficient patients with chronic heart failure in Sweden. Journal of medical economics. 2015;18(7):492-501. doi: 10.3111/13696998.2015.1029491. PubMed PMID: 25766863;
  34. Calvet X, Ruíz M, Dosal A, et al. Cost-minimization analysis favours intravenous ferric carboxymaltose over ferric sucrose for the ambulatory treatment of severe iron deficiency. PloS one. 2012;7(9):e45604. doi: 10.1371/journal.pone.0045604. PubMed PMID: 23029129; PubMed Central PMCID PMCPMC3448662 board and teaching activities. The remaining authors have declared that no competing interests exist. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materi
  35. General Authority for Statistics; Kingdom of Saudi Arabia; Gross Domestic Product 2019: GASTAT; 2019. Available from:
  36. Husereau D, Drummond M, Petrou S, et al. Consolidated Health Economic Evaluation Reporting Standards (CHEERS)—Explanation and Elaboration: A Report of the ISPOR Health Economic Evaluation Publication Guidelines Good Reporting Practices Task Force. Value in Health. 2013;16(2):231-250. doi: 10.1016/j.jval.2013.02.002.
  37. Statista. Statista Research Department; Average monthly salary in Saudi Arabia H1 2020, by sector 2020. Available from:
  38. Hejazi A, Mohamed O, Alhowimel M, et al. Ferric carboxymaltose solution versus iron sucrose complex in treating Iron-deficiency anemia patients with heavy uterine bleeding: A cost-efficacy study from a tertiary care hospital in the Kingdom of Saudi Arabia [Original Article]. 2021 January 1, 2021;12(1):17-21. doi: 10.4103/joah.joah_134_20.
  39. Al-Jamea L, Woodman A, Elnagi E, et al. Prevalence of Iron-deficiency anemia and its associated risk factors in female undergraduate students at prince sultan military college of health sciences [Original Article]. 2019 October 1, 2019;10(4):126-133. doi: 10.4103/joah.joah_44_19.
  40. Alquaiz A-JM, Khoja TAM, Alsharif A, et al. Prevalence and correlates of anaemia in adolescents in Riyadh city, Kingdom of Saudi Arabia. Public Health Nutrition. 2015;18(17):3192-3200. doi: 10.1017/S1368980015001214.
  41. Brock E, Braunhofer P, Troxler J, et al. Budget impact of parenteral iron treatment of iron deficiency: methodological issues raised by using real-life data. The European journal of health economics : HEPAC : health economics in prevention and care. 2014 Dec;15(9):907-16. doi: 10.1007/s10198-013-0533-9. PubMed PMID: 24081613;
  42. Fragoulakis V, Kourlaba G, Goumenos D, et al. Economic evaluation of intravenous iron treatments in the management of anemia patients in Greece. Clinicoecon Outcomes Res. 2012;4:127-134. doi: 10.2147/CEOR.S30514. PubMed PMID: 22629113;
  43. Bager P, Dahlerup JF. The health care cost of intravenous iron treatment in IBD patients depends on the economic evaluation perspective. Journal of Crohn's & colitis. 2010 Oct;4(4):427-30. doi: 10.1016/j.crohns.2010.01.007. PubMed PMID: 21122539;
  44. Gozzard D. When is high-dose intravenous iron repletion needed? Assessing new treatment options. Drug design, development and therapy. 2011 Jan 20;5:51-60. doi: 10.2147/dddt.S15817. PubMed PMID: 21340038; PubMed Central PMCID PMCPMC3038995