Rapid growth of intravenous iron therapy raises concerns - study

9 June 2020
Experts have found that IV iron therapy is on the rise among Australian women of reproductive age, but say investigation is needed into its effectiveness, due to potential side-effects and rising costs.

The number of Australian women of reproductive age receiving intravenous (IV) iron treatment has increased five-fold since 2013. However, experts say there needs to be more oversight, as there is a lack of strong evidence that IV iron treatment is an improvement over oral iron therapy, alongside other concerns such as side-effects and rapidly rising costs.

The findings were published in the Medical Journal of Australia. The study was led by Dr Antonia Shand, a research fellow in the University of Sydney School of Medicine and the Children’s Hospital at Westmead Clinical School and maternal fetal medicine specialist at the Royal Hospital for Women in Sydney.

“Iron deficiency, which can lead to iron deficiency anaemia, is also very common, and affects up to 14–22percent of women of reproductive age. Depending on the setting, it is usually treated with oral iron supplementation,” said Dr Shand.

“However IV iron therapy is sometimes preferred because of gastrointestinal effects from over oral iron therapy, low patient adherence of the treatment, and the delayed effect of oral iron therapy.”  

About the study

Dr Shand and her colleagues analysed dispensing data for a 10percent random sample of Australians eligible to receive subsidised medicines under the Pharmaceutical Benefits Scheme (PBS).

They included data for all women aged 18–44 years with a dispensing claim for IV iron during January 2013 to December 2017.

Key findings

  • The annual number of dispensing claims jumped from 17,920 in 2013 to 97,040 in 2017.
  • The annual rate of intravenous iron dispensing rose from 0.4 per 100 women in 2013 to 2.1 claims per 100 women in 2017.
  • In 2017, intravenous iron was dispensed to one in 50 Australian women of reproductive age –  five times the proportion in 2013.

Reason for rise ‘unclear’

Dr Shand and her colleagues say the reason for the rise in IV iron therapy was ‘unclear’ but may include increased awareness of national patient blood management guidelines around the importance of treatment of iron deficiency and anaemia,  the ease of treatment, and the perception that its side effect profile is more favourable than for oral iron therapy.

However, the increase of IV iron therapy uptake is also raising concerns.

Possible adverse outcomes of IV iron therapy include permanent skin staining and the risk (albeit rare) of potentially fatal anaphylaxis. Therefore, the researchers say intravenous iron should be administered in settings where allergic reactions can be treated promptly, but whether this is generally the case is unknown.

Since 2013, the cost of IV iron therapy has increased 35-fold.

“Intravenous iron therapy for women of reproductive age also has considerable financial implications: based on average PBS prices, its total annual cost increased 35-fold, from $750 000 in 2013 to $26.9 million in 2017,” Dr Shand and her colleagues wrote.

“The rapid growth raises concerns about whether it is being employed appropriately and cost-effectively, given the potential harms and the lack of strong evidence for its value for improving quality of life and reproductive health outcomes.”

Ivy Shih

Media and Public Relations Adviser (Medicine and Health)

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