Comparative Study on Efficacy, Tolerability and Cost of Different Iron Supplements among Ante Natal Women with Iron Deficiency Anaemia
Author(s): Sudakshina K, Sakthibalan M*, S Arthi and Mangaiarkkarasi A
Abstract
Introduction: Anaemia is one of the commonest medical complications encountered during pregnancy. India is among the countries with maximum prevalence of anaemia in the world. The commonly used treatment for iron deficiency anaemia is oral iron preparations like ferrous sulphate, ferrous gluconate, ferrous ascorbate, ferrous fumarate and parenteral iron sucrose. Aim: To assess the Mean change in the haemoglobin levels from baseline upto 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 centre, Puducherry, India, from December 2019 to December 2020, among eighty four ante natal women (>14 weeks) with iron deficiency anaemia. 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 sulphate 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 two weeks for a period of 60 days. Haemoglobin, RBC count, MCV, MCH, MCHC, WBC, Platelet count and cost of the treatment were assessed before and at the end of 60 days. Data were analysed using Graph Pad Prism software version 7.0 using Students ‘t’ test and one way ANOVA. Results: We observed a significant (P<0.001) rise in the mean haemoglobin 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, 3and 4 respectively. The average cost effectiveness ratio, with respect to group1,2,3and 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 haemoglobin concentration. But the injectable Iron sucrose showed a significant improvement in mean hemoglobin percentage compared to the various oral preparations. But, on analyzing the cost Effectiveness ratio, it was found out that the cost incurred per increase in HB% was less in ferrous sulphate group followed by Iron sucrose, ferrous fumarate and ferrous ascorbate. The results of this study can be helpful in pharmaco-economical decision making while selecting a cost effective iron supplement for treating iron deficiency anemia.