OBJECTIVES: To conduct a cost per QALY analysis of intravenous versus oral administration of iron, in anemia in Oncology, Chronic Kidney Disease (CKD) and Post-partum patients. METHODS: Intravenous iron supplementation has been shown to improve Hb response to EPO treatment, and to decrease EPO dosage requirements in patients with chronic anemia. Intravenous iron is more costly but also more effective than oral iron in treatment of anemia. A Markov model was developed for estimating incremental costs and QALYs in Oncology and CKD patients. Incremental costs were estimated for iron therapy, Erythropoietin (EPO) administration, Blood transfusion, and outpatient visits. QALY gains were estimated by linking Hb levels to QALY weights. A piggy-back approach was used for estimating costs and QALYs in anemia treatment in Post-Partum patients. Swedish prices and data representing Swedish treatment patterns and patient characteristics are derived from national databases and publications. RESULTS: In CKD patients, the cost of intravenous iron is offset by cost savings for EPO. Intravenous iron successfully corrects the anemia quicker than oral iron, resulting in a gain of 0.065 QALYs. In Oncology, the cost of IV iron is also offset by savings in EPO costs. Intravenous iron corrects the anemia quicker than oral iron and reaches a higher Hb level, with a resulting gain of 0.0759 QALYs. In post-partum patients, Hb is more quickly corrected with intravenous iron, leading to a QALY gain of 0.0086 during a six week time frame. The incremental cost for intravenous iron is 700 SEK, with a resulting cost of 68,000 SEK per QALY gained. CONCLUSION: Intravenous iron is a cost-effective alternative to oral iron, in treatment of iron deficiency anemia in oncology, CKD and post-partum patients.