Rapid increase in intravenous iron therapy for women of reproductive age in Australia

In reply: We agree with Jayasuriya and colleagues that iron deficiency anaemia may be undertreated. Intravenous iron is recommended when rapid restoration of haemoglobin and iron stores is required, oral iron cannot be tolerated, or poor absorption is expected. The National Patient Blood Management Collaborative aims to prevent transfusion and its complications by optimising haemoglobin and iron stores.1 However, randomised trials do not show evidence for benefit of intravenous iron on all outcomes in all populations, including the need for blood transfusion. A recent large randomised trial found no evidence for benefit in giving intravenous iron preoperatively to patients with anaemia undergoing major abdominal surgery.2

Although side effects may occur with oral iron, which may affect adherence, these may be dose‐related and may be ameliorated or avoided with simple steps.3 Recent studies suggest that lower dose treatment (40–80 mg) and alternate daily dosing are strategies that may be used to reduce side effects. In addition, these studies suggest twice daily doses confer no additional benefit over daily doses.4 Current evidence does not show a benefit for intravenous iron for the treatment of non‐anaemic iron deficiency, and it is not known whether women who received intravenous iron had iron deficiency or iron deficiency anaemia.4

We agree that an individual can have multiple dispensing claims, and we reported the number of dispensing claims (n = 259 700) and the number of women who received a dispensing claim (n = 190 490). Overall, three‐quarters (76.3%) of women who were administered intravenous iron received only one, 16.9% received two, and 6.8% received three or more.

We support the Choosing Wisely initiatives,5 which encourage clinicians and consumers to have better conversations about what care is truly needed, identifying which practices are helpful and which are not.