COST-EFFECTIVENESS ANALYSIS OF SCREENING FOR IRON-DEFICIENCY ANEMIA IN MIDDLE-AGED WOMEN IN JAPAN

OBJECTIVES: In Japan, the prevalence of iron-deficiency anemia (IDA) is higher than in Western countries and IDA screening is recommended for people with a history of IDA or suspected IDA during routine checkup. But there have been no studies assessing the cost effectiveness of IDA screening. The present study evaluated the cost-effectiveness of IDA screening in Japanese women aged 40 or over. METHODS: A decision analytic model was developed to compare IDA screenings followed by iron therapy with no screening from the societal perspective. We defined subjects for iron therapy as those with hemoglobin levels of less than 9.0 g/dl, as they showed improved QOL after treatment, and duration of effectiveness of therapy was assumed to be 10 years. The probability of IDA with hemoglobin of less than 9.0 g/dl, consultation after positive screening, and side-effects of iron therapy were considered. Costs of screening, consultation, iron supplementation, and lost productivity due to consultation were also included in the evaluation. We calculated the incremental cost effectiveness ratio (ICER) for IDA screening in each age group (40, 50, 60) with the prevalence of IDA in each group at 1.2%, 0.01%, 0.01%, respectively. RESULTS: Among 40-year-old women, screening generated 0.00054 higher quality adjusted life of years (QALYs) with costs at 664 yen higher. ICER at each age (40, 50, 60) was 1,234,860, 37,022,483, JPY37,022,483/QALY, respectively. A one-way sensitivity analysis revealed that ICER exceeded JPY5,000,000 when utility of IDA is higher than 0.9967. Probabilistic sensitivity analysis showed that the probability of IDA screening being less than JPY5,000,000/QALY at each age (40, 50, 60) is 95.7%, 0.0%, 0.0%, respectively. CONCLUSIONS: IDA screening is cost-effective in groups with a high prevalence of IDA. ICER worsens with decreased IDA prevalence. IDA screening should be selectively directed toward high-risk groups (i.e. 40-year-old women).