Costliness of Iron Repletion Methods in Iron Deficient Adolescent and Young Adult Females Depends on Patients Specific Factors

Background: Iron deficiency anemia is common in adolescent females due to onset of menses. Treatment options include enteral ferrous sulfate (PO), intravenous iron sucrose (IS), and intravenous ferric carboxymaltose (FC). The costliness of each method in this population is unknown. Methods: A decision analysis model evaluated these strategies in three adolescent female subgroups (AM = average BMI with moderate anemia, SA = average BMI with severe anemia, and OM = obese BMI with moderate anemia) comparing costs from a healthcare perspective. A literature review was performed to obtain model parameters. The effectiveness term was successful repletion, which was assumed identical for each strategy. Model time horizon was three months. One-way sensitivity analyses evaluated model uncertainty. Results: For AM, IS was least costly at $532 (vs. $592 for PO and $856 for FC). Varying the PO success likelihood and clinic visits needed could favor PO. In the SA group, PO was least costly at $853 (vs. $856 for FC and $936 for IS). Variation in infusions needed for IS (and therefore anemia severity) alters the preferred strategy, with IS favored for 1-4 infusions, PO favored for 5-6 infusions, and FC favored for 7 or more infusions. In the OM group, PO was preferred, costing $764 compared to $798 for IS and $856 for FC. IS was less costly at weights < 74kg (base case value 90kg). Conclusion: The costliness of iron repletion strategies depends on patient specific factors. Weight, anemia severity, and likelihood of PO adherence are important characteristics to consider.