IV Iron Dextran is the Most Cost-Effective Treatment for Iron Deficiency Anemia in HMB, With Daniel Wang

First-line treatment with intravenous (IV) iron dextran is the most cost-effective method of managing iron deficiency anemia (IDA) in women with heavy menstrual bleeding (HMB) at commonly accepted willingness-to-pay thresholds, according to a recent study.1

HMB, defined as menstrual blood loss of a sufficient volume to adversely impact a woman’s physical, emotional, social, and/or material quality of life (QoL), is a symptom of the larger issue of abnormal uterine bleeding in nonpregnant, reproductive-age women. Although data from healthcare systems suggest a prevalence of only 3-5%, past population-based studies have suggested that ≤50% of women of reproductive age are affected.2

“Conventionally, oral iron is often prescribed first because it’s very cheap,” Daniel Wang, a medical student at Yale School of Medicine and lead investigator of the study, told HCPLive in an exclusive interview. “However, for women with heavy menstrual bleeding, the volume of iron they’re losing often precludes oral iron alone to sufficiently replete their iron stores, so these women live with a chronic negative iron balance, which leads to severe iron deficiency anemia and really affects their quality of life in a variety of ways.”

Wang and colleagues developed a Markov simulation including patients aged 18-50, comparing the cost-effectiveness of first-line IV iron dextran, IV iron sucrose, and oral ferrous sulfate for IDA treatment in reproductive-age women with HMB. Costs and quality-adjusted life years (QALY) were assessed from a societal perspective, aiming to account for wages lost due to time spent on infusions.1

The team assumed that women with HMB and IDA have an iron deficit of 1000 mg, with an average menstrual blood loss of 120 mL/month in the base case. With an estimated iron loss of 0.5 mg/mL of blood with no coexisting gastrointestinal bleeding, Wang and colleagues determined a monthly iron loss of 60 mg. Additionally, the team assumed that dietary iron intake was sufficient to replace iron when menstrual losses were ≤50 mL/month. Thus, with 120 mL average monthly losses, the average patient will have a net monthly deficit of 35 mg.1

Ultimately, Wang and colleagues found IV iron dextran to be the most cost-effective treatment, with 19.26 QALYs at $157,500. This was compared to oral ferrous sulfate, which yielded 19.1 QALYs at $152,900. The incremental cost-effectiveness ratio for IV iron dextran was $28,600 per QALY. Treatment with IV ferumoxytol and iron sucrose cost $158,300 and $163,500, respectively, and provided no additional QALY benefits compared to IV iron dextran.1

Despite these data, Wang and colleagues noted several limitations to the study’s structure. Notably, the team operated under the assumption that women undergo uniform menstrual loss across the reproductive lifetime after receiving an HMB diagnosis in the base case – this assumption does not account for underlying causes of HMB, such as uterine polyps or leiomyomas, treatments to reduce menstrual volume, or possible pregnancy. Additionally, the study was by nature not capable of addressing all potential alternative oral or IV iron alternatives, which may be suggested based on cost, coverage, and personal preference. Patients may also switch medications during treatment.1

“The hope for our findings is that, while oral iron may appear to be cheaper and more cost-effective from a payer standpoint, over the entire reproductive lifespan of a patient with HMB and IDA, IV iron is going to deliver the best value for money for these patients,” Wang told HCPLive. “Our hope is that, for patients for whom this is appropriate first-line therapy, there would not be any insurance-related barriers or stepwise, sequential treatment that they have to go through.”

Editor’s Note: Wang reports support from the American Society of Hematology.

References

1. Wang D, Sra MS, Ito S, et al. Cost-effectiveness of first line IV versus oral iron for iron deficiency anemia in women with heavy menstrual bleeding. Blood Advances. Published online January 8, 2026. doi:10.1182/bloodadvances.2025018315

2. Munro MG, Mast AE, Powers JM, et al. The relationship between heavy menstrual bleeding, iron deficiency, and iron deficiency anemia. Am J Obstet Gynecol. 2023;229(1):1-9. doi:10.1016/j.ajog.2023.01.017