(1042) Direct dispensation of prenatal supplements with iron among pregnant people: a cost-effectiveness analysis

Postpartum transfusion is a leading cause of severe maternal morbidity in the United States, with pregnant individuals with iron deficiency and/or iron deficiency anemia (IDA) at increased risk. Despite early detection and treatment recommendations to reduce prenatal iron deficiency and IDA , effective strategies to overcome barriers to medication and supplement access are less clear, and iron supplement adherence remains suboptimal during pregnancy. This study compares the cost effectiveness of directly providing versus recommending prenatal iron. 

Study Design:

A decision-analytic model was constructed in TreeAge to compare directly dispensing prenatal iron supplements versus the standard protocol of recommending prenatal iron supplements in a theoretical cohort of 1,514,784 pregnant individuals enrolled in Medicare annually. Probabilities, utilities, and costs were derived from the literature. Outcomes included costs, quality-adjusted life years (QALY), preterm deliveries, neurodevelopmental disabilities, maternal postpartum anemia, and postpartum transfusion for acute blood loss. We defined our cost-effective threshold as 100,000 USD per QALY. 

Results:

Directly dispensing prenatal iron supplements resulted in 62,600 fewer preterm deliveries, 52  fewer cases of neurodevelopmental disability, 75,683 fewer cases of maternal postpartum anemia, and 54,010 fewer postpartum blood transfusions (Table 1) within our theoretical cohort. This intervention resulted in an estimated 187,475 additional QALYs and cost savings of $62,187,202,377 annually. Given the increase in QALYs and cost savings, directly dispensing prenatal iron was a dominant strategy.

Conclusion: In this study, directly dispensing prenatal iron supplements to Medicaid-enrolled pregnant individuals was a cost-effective strategy associated with reduced rates of adverse perinatal outcomes. These findings support the implementation of iron supplement provision at point of care prenatally to improve adherence, maternal and child health outcomes, and reduce healthcare expenditures.