43% of GPs had at least one patient in the last month who wasn’t able to access IV iron they needed

While more GPs than ever are prescribing IV iron, a Healthed survey suggests that many patients are missing out, both because GPs are sometimes reluctant to prescribe, but also due to prohibitive costs and difficulty or inability accessing services.

In the survey, 43% of GPs had at least one patient in the last month who would have benefited from IV iron, but couldn’t access it. Breaking this down further, one-quarter of these GPs said two or more of their patients had recently experienced this.

Reflecting on the reasons for this, 34% of GPs cited patient preference. However, the second and third most commonly cited factors were cost (32%) and lack of access to IV resources (21%).

Clinical Associate Professor Pradeep Jayasuriya of the University of Western Australia and WA Iron Centre said the survey results showed clear gaps that could be addressed with policy changes.

“There’s a lot of people now falling through the cracks. And that really requires our policymakers to take a good hard look at this and do something about it,” Associate Professor Jayasuriya said.

The IV infusion procedure isn’t covered by Medicare, so most patients will need to cover the cost of the consumables and nurse and GP time, according to Associate Professor Jayasuriya. This is typically around $200.

“It’s just disappointing that the that the government doesn’t subsidise or doesn’t give a rebate for patients to enable easier access in primary care,” he said, noting that the costs contribute to greater inequity, particularly for people who are disadvantaged, on low incomes or come from non-English speaking backgrounds.

Why are some GPs reluctant to prescribe IV iron?

In Healthed’s survey, over 60% of more than 1400 GPs who responded said they had prescribed IV iron in the past week. That’s a huge increase from a decade ago, when about 1% were prescribing it Associate Professor Jayasuriya said.

Yet 39% of GPs had not prescribed IV iron to anyone in the previous week.

Statistically, those results indicate that there is still unmet need, given that at least 12% of the population is iron deficient, and 40-50% of those with iron deficiency either experience adverse side effects with oral iron or don’t respond to it, Associate Professor Jayasuriya said.

But 30% of surveyed GPs said concerns about patient safety prevented them from recommending iron infusions.

Other barriers included time (21%), cost (18%), and medico-legal risk (17%).

In the same survey, 55% of GPs said they would not prescribe IV iron to women who have iron deficiency without anaemia who are in the second or third trimester of pregnancy, even though several studies and metanalyses have found that it is safe and effective.

Professor Jayasuriya said there is a historical fear around the safety of IV iron. Allergic reactions and anaphylaxis from IV iron were associated with the HMWID formulation which contained free iron, but this formulation is no longer on the market.

Newer formulations are much safer because the iron is very tightly bound in a carbohydrate shell which allows for a much slower release, reducing the likelihood of adverse events..

“We need GPs and doctors to realise that their perception of risk is actually incorrect. And that it’s actually much, much lower,” he said. “It’s like anything in practice: you have to do what you can to minimise risk. And I think if you follow the right protocols, the right procedures, this is really a safe activity to be undertaken in general practice,” Professor Jayasuriya explained.

He says that GPs may also be underestimating the relative benefits of IV iron compared to the safety risk.

“The alternative of doing nothing is that you leave your patients untreated, and they will suffer the poor quality of life and the poor health outcomes that come with it. So the risk benefit equation is very lopsided,” he said.

A total of 1,627 GPs responded to Healthed’s survey, which opened on 21 February 2023. GPs were allowed to skip questions, which is why each question has a different number of GP participants. Survey demographics are summarised in the charts below.

Credits

Survey conception and design– Dr Ramesh Manocha
Survey analysis, visualisation, and reporting – Yasmin Clarke
Research and editing– Lynnette Hoffman