Epidemiology and treatment of patients with iron deficiency and iron deficiency anemia: a study on longitudinal German health claims data

Iron deficiency (ID) and ID anemia (IDA), the most common deficiency diseases, may occur as isolated diseases or secondary to a causative disorder such as menorrhagia, inflammatory bowel disease (IBD), and heart disease (HD). As real-world data are limited, our objective was to assess the prevalence of ID/IDA, associated comorbidity, drug treatments focusing on trivalent ferric maltol, and healthcare resource utilization (HRU) with associated costs in Germany. This retrospective, non-interventional cohort study analyzed anonymized German health claims data covering 2016–2021. Data on patients with ID/IDA and matched control individuals, subgroups of patients with ID/IDA and concurrent disease (menorrhagia, IBD, HD), as well as patients with ID/IDA treated with ferric maltol were descriptively analyzed to evaluate prevalences, comorbidities (Elixhauser Comorbidity Index [ECI]), drug prescriptions, HRU, and HRU-associated costs. In 2021, 129,462 individuals were diagnosed with ID/IDA. Concurrent menorrhagia, IBD, and HD were observed in 34,421, 8,422, and 44,699 individuals, respectively. ID/IDA prevalences were stable throughout the study at approximately 3.3% but were higher in older individuals (up to 10.1%) and women of reproductive age (5.6–7.35%). Comorbidity burden (ECI) was two-fold higher in patients with ID/IDA than in control individuals (4.5 ± 3.6 vs. 2.3 ± 2.5, 2021 [mean ± SD]) and increased with concurrent diseases (menorrhagia [3.4 ± 2.8], IBD [5.0 ± 3.9], HD [7.9 ± 3.5]). The most frequently prescribed medication was oral bivalent iron preparation (25.0–27.5%; parenteral iron: 5.8–6.5%; oral trivalent iron: 0.2–0.7%). Ferric maltol dispensations increased slightly from 2018 to 2021 compared to other trivalent iron preparations. In patients with ID/IDA, the percentages of hospitalizations and sick leaves were higher than in control individuals (41.2% vs. 22.0%; 21.4% vs. 3.1%), corresponding to higher total costs that further increased with concurrent disease. In the subgroup of patients treated with ferric maltol (n = 686), HRU was lower in some parameters, with slightly higher ID/IDA-related total costs. Within 180 days after treatment initiation, most patients continued ferric maltol and did not switch to another iron preparation. Despite the heterogeneity of the disease, monitoring prevalence of ID/IDA, comorbidities, drug treatments, and HRU may help identify populations at increased health risk to optimize treatment strategies.