title: An economic analysis of anemia prevention during infancy.
abstract: OBJECTIVE
  To compare the cost-benefit profile of reticulocyte hemoglobin content (CHr) with hemoglobin (Hb) alone and Hb as a component of the complete blood count (CBC) for detection and treatment of iron deficiency in 9- to 12-month-old infants.
  
  
  METHODS
  Cohort simulations were used to compare CHr with Hb from a societal perspective. Assumptions included a 9% prevalence of iron deficiency and testing characteristics/costs of CHr, Hb, and CBC (CHr <27.5 pg: sensitivity 83%, specificity 72%, $11; Hb <11 g/dL: sensitivity 26%, specificity 95%, $5; CBC Hb<11g/dL, $15), as well as cost of iron therapy ($61 for established anemia). Sensitivity analyses were performed.
  
  
  RESULTS
  Under current market conditions, the incremental cost to diagnose and treat iron deficiency, compared with diagnosing and treating anemia by Hb, was only $22 per patient screened ($440 per case of anemia prevented; number needed to treat = 20). With a 10-year time horizon incorporating risks and costs of neurocognitive delays associated with untreated iron deficiency, the cost of the CHr strategy was $280 per case of anemia prevented.
  
  
  CONCLUSIONS
  CHr is an affordable strategy to prevent anemia in infants with possible iron deficiency.
authors.affiliation: Children's Hospital at Dartmouth, Lebanon, NH, USA. marcus.shaker@dartmouth.edu
authors.forename: Marcus
authors.initials: M
authors.lastname: Shaker
authors.forename: Pamela
authors.initials: P
authors.lastname: Jenkins
authors.forename: Christina
authors.initials: C
authors.lastname: Ullrich
authors.forename: Carlo
authors.initials: C
authors.lastname: Brugnara
authors.forename: Bao Tram
authors.initials: BT
authors.lastname: Nghiem
authors.forename: Henry
authors.initials: H
authors.lastname: Bernstein