Cost-effectiveness of iron deficiency screening in pregnancy across ferritin-based thresholds.
Source: PubMed, NCBI / U.S. National Library of Medicine
Maternal iron deficiency (ID) affects nearly 85% of all pregnancies worldwide by the third trimester and is significantly linked with maternal morbidity, poor birth outcomes, and cognitive and behavioral developmental deficits in children. Despite its burden to maternofetal health, no guidelines exist for the regular screening of ID in pregnant individuals in the United States. The World Health Organization (WHO) employs a diagnostic (i.e., non-screening) ferritin threshold of 15µg/L for ID in the first trimester of pregnancy, with no guidance in the second and third trimesters. Regular ID screening in pregnancy will capture the large proportion of mothers who remain undiagnosed and untreated under the current clinical status quo. Accordingly, we conducted the first cost-effectiveness analysis of ferritin-based ID screening in pregnant women in the United States, comparing thresholds of 1) 30µg/L versus 2) 15µg/L versus 3) no screening from a modified US societal perspective - accounting for wages lost to infusion time, infusion administration costs, and cost of annual hematology follow up. We found that screening at 30µg/L is the preferred strategy across extensive base case, threshold, and sensitivity analyses and across all examined willingness-to-pay (WTP) thresholds, with an incremental cost-effectiveness ratio (ICER) of $34,000/quality-adjusted life-year (QALY) [95% credible interval $32,000 - $36,200/QALY] compared with no screening. No parameter va
Abstract
Maternal iron deficiency (ID) affects nearly 85% of all pregnancies worldwide by the third trimester and is significantly linked with maternal morbidity, poor birth outcomes, and cognitive and behavioral developmental deficits in children. Despite its burden to maternofetal health, no guidelines exist for the regular screening of ID in pregnant individuals in the United States. The World Health Organization (WHO) employs a diagnostic (i.e., non-screening) ferritin threshold of 15µg/L for ID in the first trimester of pregnancy, with no guidance in the second and third trimesters. Regular ID screening in pregnancy will capture the large proportion of mothers who remain undiagnosed and untreated under the current clinical status quo. Accordingly, we conducted the first cost-effectiveness analysis of ferritin-based ID screening in pregnant women in the United States, comparing thresholds of 1) 30µg/L versus 2) 15µg/L versus 3) no screening from a modified US societal perspective - accounting for wages lost to infusion time, infusion administration costs, and cost of annual hematology follow up. We found that screening at 30µg/L is the preferred strategy across extensive base case, threshold, and sensitivity analyses and across all examined willingness-to-pay (WTP) thresholds, with an incremental cost-effectiveness ratio (ICER) of $34,000/quality-adjusted life-year (QALY) [95% credible interval $32,000 - $36,200/QALY] compared with no screening. No parameter variation changed this outcome, and screening at 30µg/L was favored in 100% of 10,000 Monte Carlo iterations. Population-level regular second and third trimester screening for ID using physiologically-informed ferritin ranges should be considered for all pregnant women in the United States.