Objective To evaluate the efficacy, safety, and economy of 4 intravenous iron formulations in the treatment of iron deficiency anemia (IDA) by rapid health technology assessment, and to provide evidence for clinical decision-making.

Methods  PubMed, Embase, the Cochrane Library, CNKI, WanFang, SinoMed, and official websites of international health technology assessment agencies were electronically searched to collect health technology assessment reports, systematic reviews/Meta-analysis, and pharmacoeconomic studies concerning the treatment of IDA with iron sucrose (IS), iron dextran (ID), ferric carboxymaltose (FCM), and iron isomaltoside (IIM) from the inception to August 15, 2024. Two researchers independently screened the studies, extracted data and assessed the quality of included studies. The results were then qualitatively described and analyzed.

Results  A total of 32 studies were included, including one health technology assessment report, 16 systematic reviews/Meta-analysis, and 15 pharmacoeconomic evaluations. In terms of effectiveness, FCM had a higher response rate than that of IS (P﹤0.05), FCM and IIM had no statistical difference (P >0.05). Regarding hemoglobin level change, patients treated with FCM had higher hemoglobin levels than those treated with IS (P﹤0.05); the improvement in hemoglobin levels between IIM and FCM was inconclusive. In terms of ferritin level change, FCM might be superior to the other three intravenous iron formulations. In terms of safety, the adverse event rates for FCM, IS, ID and IIM were 12.0%, 15.3%, 12.0% and 17.0%, respectively; IIM was significantly associated with a lower rate of cardiovascular adverse events compared to FCM and IS (P﹤0.05); FCM had the highest rate of hypophosphatemia among the four formulations (P﹤0.05), and there was no significant difference among IIM, IS and ID (P>0.05); IIM had a lower risk of severe or serious hypersensitivity reactions compared to FCM and IS. In terms of economy, FCM and IIM had an economic advantage compared to IS. The economic efficiency ranking among IS, ID, and FCM was in the order of FCM, ID, and IS, the economic comparison between FCM and IIM remains inconclusive and needs to be further demonstrated.

Conclusion  FCM and IIM have good efficacy, safety and economy in the treatment of IDA, but most of the included economy studies based on foreign populations, and domestic economic studies need to be further demonstrated.

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