Management of suspected iron deficiency: a cost-effectiveness model

Iron deficiency is frequent among physically active women. Several diagnostic and therapeutic strategies have been advocated. We determined how women's preferences for care varied with their risk of iron deficiency and/or anemia. The women's strength of feelings (utilities) and management costs were used to assess: 1) no evaluation or therapy; treatment based on a 2) complete blood count (CBC) or 3) ferritin level; and 4) empiric iron therapy. The analysis was applied to groups with differing iron deficiency prevalence. Women (N = 22) were adverse to the risk of both anemia and iron deficiency without anemia, and their preferences did not correlate with age, running mileage, years of running, or vitamin supplement use. Because of women's desire to avoid undiagnosed deficiency, the benefits of no evaluation, complete blood count assessment, and, to a less extent, serum ferritin decreased as the prevalence of iron deficiency increased. Ferritin level was more effective per cost than a CBC. However, empiric therapy had the highest effectiveness per cost. These results suggest a strategy that combines both patient concerns and the clinical suspicion of disease in choosing management for physically active women at risk for iron deficiency.