https://orcid.org/0000-0002-9336-4123
Key Points
First-line treatment with IV iron results in greater quality-adjusted life years than oral iron across the reproductive lifetime.
Treatment with IV iron dextran is cost-effective compared with treatment with IV iron sucrose, IV ferumoxytol, and oral ferrous sulfate.
Iron deficiency anemia (IDA) affects nearly one-third of women globally, with heavy menstrual bleeding (HMB) being a significant risk factor among those of reproductive age. Despite the substantial burden of HMB-related IDA, patients often face delays in receiving effective treatment. Oral iron is typically used as first-line therapy, despite frequent gastrointestinal side effects and challenges in treatment adherence. This study evaluated the reproductive lifespan cost-effectiveness of first-line intravenous (IV) versus oral iron therapy for women with HMB and IDA. We developed a Markov model simulating a cohort of women from age 18 to 51, comparing first-line treatment with IV iron dextran, IV ferumoxytol, IV iron sucrose, or oral ferrous sulfate. Costs and quality-adjusted life years (QALYs) were estimated from the societal perspective. IV iron dextran was the cost-effective treatment, yielding 19.26 QALYs at a cost of $157,500, compared with 19.10 QALYs at $152,900 for oral ferrous sulfate. The incremental cost-effectiveness ratio for IV iron dextran was $28,600 per QALY. Treatment with IV ferumoxytol and iron sucrose cost $158,300 and $163,500 respectively and did not provide additional QALY benefit compared with IV iron dextran, which remained the cost-effective treatment across a range of scenarios and sensitivity analyses. Our findings indicate that first-line treatment with IV iron dextran is the cost-effective strategy for managing IDA in women with HMB at commonly accepted willingness-to-pay thresholds. These results support expanding access to IV iron as a first-line option and highlight the need to reduce treatment delays and insurance-related barriers.
