PT  - JOURNAL ARTICLE
AU  - Sarah Carsley
AU  - Rui Fu
AU  - Cornelia M. Borkhoff
AU  - Nadine Reid
AU  - Eva Baginska
AU  - Catherine S. Birken
AU  - Jonathon L. Maguire
AU  - Rebecca Hancock-Howard
AU  - Patricia C. Parkin
AU  - Peter C. Coyte
TI  - Iron deficiency screening for children at 18 months: a cost-utility analysis
AID  - 10.9778/cmajo.20190084
DP  - 2019 Oct 01
TA  - CMAJ Open
PG  - E689--E698
VI  - 7
IP  - 4
4099  - http://www.cmajopen.ca/content/7/4/E689.short
4100  - http://www.cmajopen.ca/content/7/4/E689.full
SO  - CMAJ2019 Oct 01; 7
AB  - Background: The peak prevalence of iron deficiency is in children 6 months to 3 years of age, a sensitive period for neurodevelopment. Our study objective was to examine the cost-utility of a proposed iron deficiency screening program for 18-month-old children.Methods: We used a decision tree model to estimate the costs in 2019 Canadian dollars and quality-adjusted life years (QALYs) associated with 3 iron deficiency screening strategies: no screening, universal screening and targeted screening for a high-risk population. We used a societal perspective and assessed lifetime QALY gains. We derived outcomes from the literature and prospectively collected data. We performed one-way and probabilistic sensitivity analyses to assess parameter uncertainty.Results: The incremental costs to society of universal and targeted screening programs compared to no screening were $2286.06/QALY and $1676.94/QALY, respectively. With a willingness-to-pay threshold of $50 000/QALY, both programs were cost-effective. Compared to a targeted screening program, a universal screening program would cost an additional $2965.96 to gain 1 QALY, which renders it a cost-effective option. The study findings were robust to extensive sensitivity analyses.Interpretation: A proposed universal screening program for iron deficiency would be cost-effective over the lifespan compared to both no screening (current standard of care) and a targeted screening program for children at high risk. Policy-makers and physicians may consider expanding the recommended 18-month enhanced well-baby visit to include screening for iron deficiency.