目的:本研究比较了肠外铁剂的临床疗效和成本效益,在古吉拉特邦的自然初级保健机构中,使用静脉内蔗糖铁(IVIS)疗法与口服铁(OI)疗法的标准方案来管理孕妇的缺铁性贫血(IDA)。
方法:在自然计划环境中进行了一项前瞻性成本效益研究,其中来自古吉拉特邦两个地区的188名孕妇在14至18周内患有中度和重度贫血,142例随访至产后阶段.干预组由82名接受IVIS治疗的参与者组成,而对照组由106名接受OI治疗的参与者组成。定期测量血红蛋白(Hb)水平,首先在登记期间,然后在怀孕期间的每个月,最后在产后第42天。
方法:平均Hb水平从基线的变化是主要结果,而发病率和死亡率是次要结局指标.
结果:在第四次随访时,干预组显示Hb水平从8.2g/dl到11.45g/dl的显着递增平均变化,而对照组的平均血红蛋白水平从9.99g/dl降至9.55g/dl。IVIS的每个受益人的折扣成本为87美元,而OI的折扣成本为49美元。增量成本效益比(ICER)为9.84美元,占印度人均GDP的0.049%。
结论:IVIS疗法比OI疗法在妊娠妇女治疗中度和重度贫血方面更具临床效果和成本效益。
OBJECTIVE: This study compared the clinical efficacy and cost-effectiveness of parenteral iron, using intravenous iron sucrose (IVIS) therapy against the standard regimen of oral iron (OI) therapy for managing iron-deficiency anemia (IDA) among pregnant women in a natural primary care setting in Gujarat.
METHODS: A prospective cost-effectiveness study was conducted in natural programme setting wherein 188 pregnant women in their 14 to 18 weeks with moderate and severe anemia women enrolled from two districts of Gujarat, and 142 were followed up until the post-partum phase. The intervention group comprised of 82 participants who were administered IVIS, while the comparison group comprised of 106 participants who were put on OI therapy. Hemoglobin (Hb) levels were measured at periodic intervals, first during enrollment and then during each month of pregnancy period and finally on the 42nd day of the post-natal period.
METHODS: Change in mean Hb level from baseline was the primary outcome, while the incidence of morbidity and mortality was a secondary outcome measure.
RESULTS: The intervention group showed a significant incremental mean change in Hb level from 8.2 g/dl to 11.45 g/dl at the fourth follow-up, while the control group\'s mean Hb level reduced from 9.99 g/dl to 9.55 g/dl. The discounted cost per beneficiary for IVIS was US$ 87, while that for OI was US$ 49. The incremental cost-effectiveness ratio (ICER) was US$ 9.84, which is 0.049% of India\'s per capita GDP.
CONCLUSIONS: IVIS therapy was more clinically effective and cost-effective than OI therapy among pregnant women for management of moderate and severe anemia.