Evaluating Economic and Clinical Impacts of Anaemia Management Strategies: A Systematic Review of the Evidence From the UK Perspective.
Farabi H., Tomini F., Evans H., Murphy MF., Green L., Dhiman P., Fabiano G., Palmer AJR., von Neree L., Stanworth SJ.
BACKGROUND: Anaemia significantly affects health outcomes and quality of life. While blood transfusion remains a common intervention, alternative treatments, such as iron supplementation and erythropoiesis-stimulating agents (ESAs), offer potential to mitigate transfusion-associated costs. However, robust evidence on their cost-effectiveness remains limited. OBJECTIVE: This review assesses the cost-effectiveness of anaemia treatments, aiming to inform UK healthcare policy and practice. METHODS: A systematic review was conducted following PRISMA guidelines, identifying economic evaluations published between 2015 and 2025. Study quality was appraised using the Drummond checklist and NICE reference case criteria. Data were synthesised using the Hierarchical Decision Matrix framework. RESULTS: Of 5496 records screened, 14 studies met inclusion criteria; 11 were included in the final synthesis, with three excluded due to low methodological quality. Restrictive transfusion strategies were cost-saving (£35.50-£75 per patient), reduced red blood cell utilisation by ∼21%, shortened length of stay by 0.5 to 3 days, and yielded modest QALY gains (0.01 to 0.02). ESAs reduced transfusion risk (RR 0.61 to 0.87) but incurred substantial incremental costs (£1859-£3060) with limited evidence of QALY gains. Transfusion of fresher blood in ICU settings increased costs without a measurable clinical or economic advantage. Preoperative erythropoietin and ferric carboxymaltose reduced transfusion incidence but were high-cost interventions with limited evidence on QALY gains. Patient Blood Management (PBM), particularly intravenous iron, was cost-saving (£30.80-1166 saved per patient), reduced transfusion rates (RR 0.61), but with limited evidence on QALY gains. CONCLUSION: Restrictive transfusion thresholds and PBM interventions, especially intravenous iron, demonstrate favourable cost-effectiveness and potential for NHS cost savings. In contrast, the cost-effectiveness of ESAs remains uncertain due to high costs and limited utility evidence. Further research is needed to capture long-term outcomes and generate UK-specific economic data. TRIAL REGISTRATION: The authors have confirmed clinical trial registration is not needed for this submission.