Iron Chelating Agents, February 2014
Drug utilisation sub-committee (DUSC)
February 2014
Full report on Iron Chelating Agents (PDF 509 KB)
Full report on Iron Chelating Agents (Word 325 KB)
Abstract
Purpose
To review utilisation of iron chelating therapies. At its March 2013 meeting, the Pharmaceutical Benefits Advisory Committee (PBAC) considered that iron chelation therapy was overused in myelodysplastic syndrome (MDS) and may provide limited benefits in patients with short life expectancy. The PBAC requested a utilisation analysis of the iron chelating class of drugs (desferrioxamine, deferiprone and deferasirox).
Background
Desferrioxamine, deferiprone and deferasirox are listed on the Pharmaceutical Benefits Scheme (PBS) as iron chelating agents. Iron chelating therapy is used to remove excess iron in patients with transfusion-dependent conditions such as beta thalassaemia major, sickle cell anaemia and MDS. Frequent blood transfusions in these patient groups may result in an accumulation of iron in the body. Decreasing iron through the use of iron chelation therapy reduces the production of reactive oxygen species, thus reducing damage to critical organs.
Date of listing on the PBS
- Desferrioxamine: October 1992;
- Deferiprone: tablets February 2004, oral solution, June 2009;
- Deferasirox: 1 December 2006
Data Source / methodology
The analysis examined de-identified prescription and Government expenditure data for desferrioxamine, deferiprone and deferasirox from January 2009 until June 2013. The Highly Specialised Drugs (HSD) database was used to obtain information regarding the number of prescriptions, packs and cost of the drugs. A patient level analysis of de-identified Department of Human Services (Medicare) claim data was used to examine the age and sex of the patients.
Key Findings
- Utilisation and expenditure for the iron chelating agents has almost doubled between 2007 and 2013.
- The increase was predominantly driven by the increasing use of the 500 mg strength of deferasirox.
- The utilisation of deferasirox 500 mg is higher than that proposed at the time of listing.
- Most patients treated with deferasirox are over the age of 55. It is probable that much of the use in older patients is for MDS. The extent of use for MDS has been higher than expected at the time of listing and the incremental cost-effectiveness ratio of iron chelating agents used in MDS has not been established and is likely to be higher than for conditions such as thalassemia.
PBS/RPBS expenditure for the 2012/13 financial year was:
| Desferrioxamine | $764,161 |
| Deferiprone | $638,223 |
| Deferasirox | $20,460,390 |
| Total cost | $21,862,774 |
