Cost-effectiveness of Intravenous Iron Sucrose for Treating Anemia in Pregnancy: A Model-based Cost Utility Analysis.

BACKGROUND: Anemia is one of the most common nutritional deficiencies among pregnant women, often causing adverse maternal and fetal outcomes. While oral iron has been the primary strategy for managing anemia, however, issues related to compliance and absorption have limited its effectiveness. Intravenous iron sucrose has emerged as a potential alternative, but its cost-effectiveness remains underexplored. OBJECTIVES: The present study was undertaken to assess the cost-effectiveness of intravenous iron sucrose compared to oral iron for moderately anemic pregnant women in India. MATERIALS AND METHODS: A decision-tree model was developed to estimate the costs and outcomes of anemia in maternal and fetal/newborn populations. The analysis adopted an abridged societal perspective, considering health system costs and out-of-pocket expenditures. Indirect costs were included in the sensitivity analysis. Deterministic and probabilistic sensitivity analyses were undertaken to assess the robustness of findings. RESULTS: The use of intravenous iron sucrose has an incremental cost-effectiveness ratio (ICER) of Indian National Rupee (INR) 30,397 per disability adjusted life year averted and INR 7489 per quality-adjusted life year gained. These ICERs are below the threshold of 1-time gross domestic product per capita, indicating that intravenous iron sucrose is a cost-effective therapy. The results were sensitive to extreme variations in treatment adherence rates. CONCLUSION: Intravenous iron sucrose proves to be a cost-effective strategy for managing moderate anemia in pregnancy compared to oral iron and should be considered as first-line therapy. Furthermore, adherence to therapy is a crucial factor influencing the success of intravenous iron. Therefore, concerted efforts aimed at improving treatment adherence are recommended.