Intravenous iron use among Australian women climbs dramatically over the past decade

The number of Australian women receiving intravenous iron treatments has surged dramatically over the past decade, with new research revealing that one in 20 women of reproductive age received intravenous iron in 2024.

The new study by researchers at Flinders University, SAHMRI and collaborating institutions found a 17-fold increase in intravenous iron use among women aged 18 to 44 years between 2013 and 2024, with government and patient spending on the medication alone rising from $1.1 million to more than $82 million.

Out-of-pocket costs for women can also be substantial, with some clinics charging hundreds of dollars for an infusion.

Iron deficiency is one of the most common health issues affecting women, particularly during the reproductive years. Heavy menstrual bleeding, pregnancy, childbirth and breastfeeding can all increase the body's demand for iron.

Left untreated, iron deficiency can cause debilitating fatigue, poor concentration, reduced physical capacity and decreased quality of life.

The researchers analyzed Pharmaceutical Benefits Scheme (PBS) data from 2013 to 2024 and found intravenous iron use increased from 0.3 women per 100 in 2013 to 5.0 women per 100 in 2024.

The researchers also found almost one in four women did not complete their prescribed treatment course, raising questions about whether some women may be receiving less treatment than intended. Possible explanations include women feeling better after an initial dose or the financial burden associated with additional treatment.

The study found that ferric carboxymaltose, a newer form of intravenous iron, now accounts for almost 94 per cent of all prescriptions. General practitioners were responsible for more than 60 per cent of prescriptions in 2024.

Senior author Associate Professor Luke Grzeskowiak says the findings reflect growing awareness of the impact iron deficiency can have on women's health.

For women struggling with iron deficiency, particularly when oral iron tablets are ineffective or cause troublesome side effects, intravenous iron can be an important treatment option. It can replenish iron stores more quickly and help women feel better sooner, which can make a real difference to their daily lives."

 Professor Grzeskowiak from Flinders University's College of Medicine and Public Health

However, the study also identified substantial differences in overall treatment rate, as well as the type and dose of intravenous iron received, depending on where women lived, their age, concession card status and who prescribed the treatment. In some parts of Australia, rates of use were more than three times higher than others.

Lead author, Dr Gizat Kassie from SAHMRI, says the variation raises important questions about access to treatment and consistency of care.

"We need to better understand what is driving these differences and whether all women are receiving equitable access to the most appropriate treatment," he says.

"Some of the variation may reflect differences in clinical practice, but cost could also be playing a role. For some women, out-of-pocket expenses can be significant and may influence both access to treatment and whether they complete the recommended course.

"The finding that almost one-quarter of women did not complete their prescribed treatment course is also important. We don't yet know why, but it raises the possibility that some women may not be receiving the full benefit of treatment."

The researchers note that while intravenous iron is generally safe and effective, it is usually recommended when oral iron has failed, cannot be tolerated, or when rapid replacement of iron stores is needed. Like all medical treatments, it can carry risks and costs that need to be carefully considered.

Professor Grzeskowiak says the findings highlight the need to ensure women receive the right care at the right time.

"Iron deficiency can have a significant impact on women's health and wellbeing, but it is treatable," he says.

"Our findings show that intravenous iron has become an increasingly important part of care for Australian women, and we need to make sure its use remains evidence-based, effective and equitable."