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. 2025 Apr 24;5(4):e0004392.
doi: 10.1371/journal.pgph.0004392. eCollection 2025.

The cost-effectiveness of interventions used for the screening, diagnosis and management of anaemia in pregnancy: A systematic review

Connor Luke Allen  1   2 , Katherine Eddy  2 , Joshua F Ginnane  2 , Sarah Cheang  1   2 , Renae Nguyen  2 , Nick Scott  1   2 , Joshua P Vogel  1   2 , Annie McDougall  2   3
Affiliations

The cost-effectiveness of interventions used for the screening, diagnosis and management of anaemia in pregnancy: A systematic review

Connor Luke Allen et al. PLOS Glob Public Health. .

Abstract

An estimated 40% of pregnant women worldwide are anaemic, of which 80% live in low- and middle-income countries (LMICs). The reality of finite health budgets, particularly in low-resource settings, means that interventions used for screening, diagnosing, and treating anaemia in pregnancy need to be informed by cost-effectiveness evidence. We conducted a systematic review to identify all studies evaluating the cost-effectiveness of managing anaemia in pregnancy. We searched two health economics (NHS EED and EconLit) and four medical (MEDLINE, Embase, CINAHL Plus and CENTRAL) databases for relevant studies published up to the 9th of August 2024. Studies were eligible if they conducted an economic evaluation of any intervention used in the management of anaemia in pregnancy regardless of aetiology, provided that anaemia was a specified outcome. Data were extracted and study quality assessed by two independent reviewers using the extended CHEC-E tool. Due to significant heterogeneity, data were analysed narratively. 19 eligible cost-effectiveness studies were identified. Nine studies related to iron deficiency anaemia, finding that intravenous rather than oral iron supplements were cost-effective in most instances. Multiple micronutrient supplements were also found to be cost-effective compared to iron and folic acid supplements. Ten studies related to malaria-related anaemia, identifying several cost-effective antimalarial regimens; both preventative and therapeutic. Cost-effective delivery channels of antimalarials as well as non-pharmacological interventions were also identified. This review identifies several avenues through which the management of anaemia in pregnancy can be optimised from an economic perspective. Despite this, there is a significant deficit of cost-effectiveness evidence relating to this condition, which limited the deduction of cost-effectiveness for many of the interventions assessed.

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Conflict of interest statement

The authors have declared that no competing interests exist.

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Fig 1. PRISMA Flowchart.
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