Daniel Wang: A More Appropriate Ferritin Threshold is Cost-Effective for Iron Deficiency Screening

Screening for iron deficiency (ID) at a ferritin threshold of under 25µg/L is a cost-effective and more accurate identification and treatment strategy for women with ID.

These findings were presented at the 66th American Society of Hematology (ASH) Annual Meeting and Exposition, held December 7-10, 2024, in San Diego, California, by Daniel Wang, Yale School of Medicine.

“The current world health organization guidelines have the lower limit of normal for serum ferritin at 15 micrograms per liter, whereas we know from physiological studies… that a more appropriate threshold is probably 25-to-30, maybe even as high as 50 micrograms per liter, so a huge swath of women of reproductive age who are just going undiagnosed and untreated in a lot of cases,” Wang told HCPLive® during the meeting.

Wang and colleagues found that screening for ID with a ferritin threshold under 25µg/L is the cost-effective strategy in 100% of 10,000 Monte Carlo iterations, accruing $212,000 in costs and generating 24.3 Quality-Adjusted Life Years (QALYs), compared with $211,000 and 23.3 QALYs with a screening threshold of 15 µg/L, or $210,000 and 22.3 QALYs with no screening. Overall, the data show that the incremental cost-effectiveness ratio of 25 µg/L compared to no screening is $940/QALY which is accepted under willingness-to-pay thresholds in the United State.

The investigators also found that treatment with iron dextran (ICER = $1,700/QALY) is also cost-effective in patients with ID. These findings were supported with sensitivity analyses.

“…Cost should not be a barrier for the screening and treatment of these women and at a population level. If we can raise the bar, I really think so, so many people would benefit,” Wang said.

REFERENCE

Wang D, Glaeser-Khan S, Wang DY, et al. Sex, Lies, and Iron Deficiency in 2024: Cost-Effectiveness of Screening Ferritin Thresholds for the Treatment of Iron Deficiency in Women of Reproductive Age. Presented at: ASH Annual meeting; December 7-10; San Diego, California. Abstract 277