Comparative study on efficacy, tolerability, and cost of different iron supplements among antenatal women with iron-deficiency anemia

Abstract

Background: Anemia is one of the most common medical complications encountered during pregnancy. India is among the countries with maximum prevalence of anemia in the world. The commonly used treatment for iron-deficiency anemia is oral iron preparations such as ferrous sulfate, ferrous gluconate, ferrous ascorbate, ferrous fumarate, and parenteral iron sucrose. Aims and Objectives: The aims of this study were to assess the mean change in the hemoglobin levels from baseline up to 60th day of treatment with different iron supplements and to assess its cost effectiveness ratio. Materials and Methods: This was a prospective interventional clinical end point study conducted at Sri Venkateshwaraa Medical College Hospital and Research Center, Puducherry, India, from December 2019 to December 2020, among 84 antenatal women (>14 weeks) with iron-deficiency anemia. After getting ethics committee approval, the participants who fulfilled the inclusion and exclusion criteria were randomized to respective treatment groups. Group 1 (n = 21) received ferrous sulfate 200 mg, Group 2 (n = 21) received ferrous ascorbate 200 mg, Group 3 (n = 21) received ferrous fumarate 200 mg twice daily for a period of 60 days, and Group 4 (n = 21) received Iron sucrose 200 mg, based on iron requirement in divided doses and administered once in 2 weeks for a period of 60 days. Hemoglobin (Hb), RBC count, mean corpuscular volume, mea n corpuscular Hb (MCH), MCHC, WBC, platelet count, and cost of the treatment were assessed before and at the end of 60 days. Data were analyzed using GraphPad Prism software version 7.0 using Student “t”-test and one-way ANOVA. Results: We observed a significant (P < 0.001) rise in the mean Hb level from 10.4 ± 0.4, 10.4 ± 0.5, 10.4 ± 0.5 and 8.5 ± 0.3 to 11.2 ± 0.6 (P = 0.0001), 11.1 ± 0.6 (P = 0.0001), 11.3 ± 0.8(P = 0.0001), and 10.9 ± 0.6 (P = 0.0001) in Group 1, 2, 3, and 4, respectively. The average cost effectiveness ratio, with respect to Groups 1, 2, 3, and 4 was Rs. 675, Rs. 1782.9, Rs. 1110.7, and Rs. 786.7 per increase in Hb%, respectively. Conclusion: The outcome of this study proved the effective role of various oral ferrous iron preparations and all of them were found to be equally efficacious in improving the Hb concentration. However, the injectable iron sucrose showed a significant improvement in mean hemoglobin percentage compared to the various oral preparations. However, on analyzing the cost-effectiveness ratio, it was found out that the cost incurred per increase in Hb% was less in ferrous sulfate group, followed by iron sucrose, ferrous fumarate, and ferrous ascorbate. The results of this study can be helpful in pharmacoeconomical decision making while selecting a cost effective iron supplement for treating iron-deficiency anemia.

Prevention and Management of Iron Deficiency/Iron-Deficiency Anemia in Women: An Asian Expert Consensus

“…The size of the expert panel may not be representative of all Asia-Pacific countries, and therefore not generalizable to women outside of the represented countries with differing cultures and values, healthcare access, and quality of care received. For example, pregnant women in developing countries of low socioeconomic status, such as India, are less likely to receive timely iron status assessment or adhere to iron supplementation [ 93 , 94 ]. Secondly, the absence of online or in-person meetings after each Delphi round may have deprived panelists from exchanging pertinent information and clarifying reasons for disagreement.…”