An Observational Comparative Study of Oral and Intravenous Iron Therapy for Iron Deficiency Anemia in a Tertiary Care Hospital

Background

Iron Deficiency Anemia (IDA) is one of the most prevalent nutritional disorders in the world associated with substantial morbidity. Intravenous iron therapy has been considered as a more efficacious alternative to standard oral iron therapy because of its rapid correction of iron deficiency, improved tolerability, and better compliance among patients.

Objectives

This study aimed to compare the efficacy, safety, and cost-effectiveness of intravenous iron with oral iron in the treatment of IDA.

Materials and Methods

A Prospective observational study was conducted at tertiary care hospital, over a six-month among 84 adult patients diagnosed with IDA who received oral iron or intravenous iron therapy. Hemoglobin levels before and after iron therapy were compared using paired t-tests. Analysis of Covariance (ANCOVA) was performed to compare post treatment hemoglobin after adjustment for baseline hemoglobin as covariate and two-way repeated-measures ANOVA evaluated changes over time and between groups. A p-value <0.001 was considered statistically significant.

Results

The study comprises 9 males and 75 females, with a predominance of premenopausal women. Hemoglobin levels increased significantly in both groups following iron therapy. Patients receiving intravenous iron therapy demonstrated a significant increase in hemoglobin 2.13 g/dL compared with oral iron therapy 0.56 g/dL. ANCOVA demonstrated a significant difference in post treatment hemoglobin between groups F (1,81) = 5.71, p = 0.019. ANOVA showed significant effects of time F (1,82) = 139.1, p<0.001, and significantly time × treatment interaction F (1,82) = 47.4, p<0.001, indicating superior hematological improvement with intravenous iron therapy. Gastrointestinal adverse effects occurred in 21.4% participants receiving oral iron therapy, whereas mild hypersensitivity reactions in 11.90% in patients administered with intravenous iron therapy. The Incremental Cost-Effectiveness Ratio (ICER) for intravenous iron therapy was ₹4076.43 per additional g/ dL increase in haemoglobin.

Conclusion

Both intravenous and oral iron therapy significantly improve hemoglobin levels, with greater improvement observed in intravenous therapy, offering a safe and efficient alternative to patients with moderate to severe iron deficiency anemia. The between group difference remained significant after adjustment for baseline hemoglobin.