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Iron deficiency screening for children at 18 months: a cost-utility analysis
Sarah Carsley1, Rui Fu2, Cornelia M Borkhoff2
1Health Promotion, Chronic Disease and Injury Prevention (Carsley), Public Health Ontario; Institute of Health Policy, Management and Evaluation (Fu, Borkhoff, Reid, Baginska, Birken, Maguire, Hancock-Howard, Parkin, Coyte), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences (Borkhoff, Birken, Parkin), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children; Division of Pediatric Medicine and the Pediatric Outcomes Research Team (Borkhoff, Birken, Maguire, Parkin), Department of Pediatrics, Faculty of Medicine, University of Toronto, The Hospital for Sick Children; Department of Pediatrics (Maguire), St. Michael's Hospital and Li Ka Shing Knowledge Institute; Department of Nutritional Sciences (Birken, Maguire), University of Toronto, Toronto, Ont. sarah.carsley@oahpp.ca.
Insights
Universal iron deficiency screening for 18-month-olds is cost-effective. This program offers better value than targeted screening or no screening, improving neurodevelopmental outcomes.
Area of Science:
- Pediatric Health
- Public Health Policy
- Health Economics
Background:
- Iron deficiency (ID) peaks in children aged 6 months to 3 years, a critical period for neurodevelopment.
- Current standard of care involves no routine screening for iron deficiency in this age group.
Purpose of the Study:
- To evaluate the cost-utility of implementing a universal iron deficiency screening program for 18-month-old children.
- To compare universal screening with targeted screening and no screening strategies.
Main Methods:
- A decision tree model was utilized to estimate costs (2019 Canadian dollars) and quality-adjusted life years (QALYs).
- A societal perspective was adopted, assessing lifetime QALY gains.
- Data were derived from literature and prospective collection, with sensitivity analyses performed.
Main Results:
- Both universal and targeted screening programs were found to be cost-effective at a willingness-to-pay threshold of $50,000/QALY.
- Universal screening yielded an incremental cost of $2965.96 per QALY gained compared to targeted screening, remaining cost-effective.
- Sensitivity analyses confirmed the robustness of these findings.
Conclusions:
- A universal iron deficiency screening program for 18-month-olds is a cost-effective strategy over the lifespan.
- The findings support expanding the 18-month well-baby visit to include iron deficiency screening.
- Policy-makers and clinicians should consider implementing universal screening to improve child health outcomes.
Background:
The peak prevalence of iron deficiency is in children 6 months to 3 years of age, a sensitive period for neurodevelopment. Our study objective was to examine the cost-utility of a proposed iron deficiency screening program for 18-month-old children.
Methods:
We used a decision tree model to estimate the costs in 2019 Canadian dollars and quality-adjusted life years (QALYs) associated with 3 iron deficiency screening strategies: no screening, universal screening and targeted screening for a high-risk population. We used a societal perspective and assessed lifetime QALY gains. We derived outcomes from the literature and prospectively collected data. We performed one-way and probabilistic sensitivity analyses to assess parameter uncertainty.
Results:
The incremental costs to society of universal and targeted screening programs compared to no screening were $2286.06/QALY and $1676.94/QALY, respectively. With a willingness-to-pay threshold of $50 000/QALY, both programs were cost-effective. Compared to a targeted screening program, a universal screening program would cost an additional $2965.96 to gain 1 QALY, which renders it a cost-effective option. The study findings were robust to extensive sensitivity analyses.
Interpretation:
A proposed universal screening program for iron deficiency would be cost-effective over the lifespan compared to both no screening (current standard of care) and a targeted screening program for children at high risk. Policy-makers and physicians may consider expanding the recommended 18-month enhanced well-baby visit to include screening for iron deficiency.
