Cost-Effectiveness of Ferritin Screening Thresholds for Iron Deficiency in Reproductive-Age Women

Iron deficiency (ID) is a top five leading cause of disability-adjusted life-years in women of reproductive age around the world. Despite its enormous health burden, no screening guidelines exist for the detection and treatment of ID in women of reproductive age. We sought to determine the cost-effectiveness of screening versus no screening for ID in women of reproductive age in the United States. A lifetime simulation of women of reproductive age was conducted using a Markov cohort model under three strategies: (1) no screening, (2) screening at a ferritin threshold of 15 μg/L, and (3) screening at a ferritin threshold of 25 μg/L, from the US health system perspective, and at a willingness-to-pay threshold of $100 000/quality-adjusted life year (QALY). Epidemiologically informed ID prevalence estimates sourced from the National Health and Nutrition Examination Survey were employed for model parameterization. The primary outcome was the incremental cost-effectiveness ratio (ICER, in $/QALY). Base-case results for the three strategies accrued $209 700, $210 200, and $210 200 discounted lifetime costs and 23.6, 24.0, and 24.4 discounted lifetime QALYs, respectively. Screening at a ferritin threshold of 25 μg/L was the cost-effective intervention with an ICER of $680/QALY (95% credible interval $350-$750/QALY). In dual base-case analyses examining intravenous rather than oral iron repletion for treatment, screening at a ferritin threshold of 25 μg/L remained the cost-effective intervention with an ICER of $2300/QALY (95% CI $1800-$3800/QALY). In probabilistic sensitivity analyses, screening at a ferritin threshold of 25 μg/L was the cost-effective intervention in 100% of 10 000 second order Monte Carlo iterations.