Research presented at the 66th American Society of Hematology (ASH) Annual Meeting reveals that raising the ferritin threshold for iron deficiency screening could significantly improve detection and treatment outcomes in women of reproductive age.
The study, led by Daniel Wang from Yale School of Medicine, challenges the current World Health Organization guidelines, which set the lower limit of normal serum ferritin at 15 micrograms per liter. "A more appropriate threshold is probably 25-to-30, maybe even as high as 50 micrograms per liter," Wang explained, highlighting that "a huge swath of women of reproductive age who are just going undiagnosed and untreated in a lot of cases."
Economic Analysis and Health Outcomes
The research team conducted comprehensive cost-effectiveness analyses using Monte Carlo simulations. Screening at a ferritin threshold of 25µg/L proved superior in all 10,000 iterations, demonstrating both clinical and economic benefits:
- Cost: $212,000 with 24.3 QALYs (25µg/L threshold)
- Cost: $211,000 with 23.3 QALYs (15µg/L threshold)
- Cost: $210,000 with 22.3 QALYs (no screening)
The incremental cost-effectiveness ratio (ICER) of implementing the 25µg/L threshold compared to no screening was $940/QALY, well within accepted willingness-to-pay thresholds in the United States.
Treatment Implications
The study also evaluated treatment options, finding iron dextran to be a cost-effective intervention for patients with iron deficiency, with an ICER of $1,700/QALY. These findings remained robust through sensitivity analyses.
"Cost should not be a barrier for the screening and treatment of these women," Wang emphasized, "and at a population level, if we can raise the bar, I really think so many people would benefit."
The findings suggest that healthcare systems could significantly improve women's health outcomes by adopting this higher screening threshold, potentially identifying and treating many cases of iron deficiency that currently go unrecognized under existing guidelines.
