Lancet Haematology最新文献

Background: Anaemia causes widespread health and economic harm. Current international targets for reducing anaemia in women of reproductive age, including the Sustainable Development Goal of halving prevalence by 2030, are unlikely to be met by any signatory country. This outcome suggests that current targets were grounded in aspiration rather than a systematic assessment of what is achievable given current recommended interventions and national health-care priorities. We propose a novel method of target setting for global health goals, with reducing anaemia in women of reproductive age as an example.

Methods: In this modelling study, we developed a country-level health economic model to support feasible and ambitious target-setting for anaemia for women of reproductive age (aged 15-49 years) based on cost-effectiveness analysis and applied it to 191 signatory countries. Our model integrated country-specific data on the current prevalence of anaemia, the effectiveness and current and maximal coverage of recommended interventions available to each country, the local unit costs of these interventions, and country-specific cost-effectiveness threshold estimates, including Global Burden of Disease data and data from the Demographic and Health Survey Program. Interventions were applied to maximise health gains subject to country-level cost-effectiveness thresholds at 1 × gross domestic product per capita. We assessed parameter uncertainty through Monte Carlo simulations and scenarios that considered alternative thresholds, constraints on cost, and coverage.

Findings: Our results indicate that an ambitious, achievable, and cost-effective global target for anaemia reduction in women aged 15-49 years by 2030 is 17% (95% uncertainty interval [UI] 5-34). The maximum achievable target removing all cost constraints is a 22% (11-36) reduction. No scenario approached the current 50% global Sustainable Development Goal reduction target, indicating that this goal is unachievable with existing recommended interventions. Reduction targets for individual countries ranged from 0% to 29%, with substantial variation both between and within regions and income groups.

Interpretation: Our findings suggest that a value-based global target for anaemia reduction will be substantially lower than the existing international commitment. Value-based targets using evidence from available interventions and cost-effectiveness for what is achievable given countries' differing contexts can provide better incentives for progress and offer more realistic forecasts of human development.

Funding: Gates Foundation.

Background: Regular blood donation is associated with an increased risk of iron deficiency and anaemia. Oral iron supplementation is known to shorten post-donation iron recovery time and could serve as an alternative to extended donation intervals. We aimed to evaluate the effect of different iron supplementation protocols on ferritin and haemoglobin levels, gastrointestinal side-effects, iron deficiency-related symptoms, and donor return compared with placebo supplementation.

Methods: In this double-blind, randomised, placebo-controlled trial conducted at seven of Sanquin's blood donation centres in The Netherlands, donors aged 18-80 years with ferritin levels equal to or less than 30 μg/L were randomly allocated to one of six study groups, using block randomisation in equal numbers by sex and age. Donors were instructed to adhere to a ferrous bisglycinate supplementation protocol for 56 days, taking capsules containing 0 mg (placebo), 30 mg, or 60 mg of elemental iron, either daily or on alternate days. The primary outcomes were presence of iron deficiency (<15 μg/L), low ferritin (15-30 μg/L), and low haemoglobin (≤135 g/L for male donors and ≤125 g/L for female donors) at 56 days' follow-up. Analyses were conducted using an intention-to-treat approach. This trial is registered in the Dutch trial registry (NL7328.018.20) and is complete.

Findings: Between Aug 1, 2021, and Jan 15, 2023, 830 donors (464 [56%] female donors and 366 [44%] male donors; 789 [95%] of Dutch origin and 26 [3%] of non-Dutch origin) had low ferritin and were included in the trial. At 56 days, 55 (51%) of 108 participants in the placebo daily group, 58 (49%) of 119 participants in the placebo alternate day group, 11 (10%) of 107 participants in the 30 mg daily group, eight (7%) of 112 participants in the 30 mg alternate day group, one (1%) of 114 participants in the 60 mg daily group, and four (4%) of 110 participants in the 60 mg alternate day group presented with iron deficiency. Compared with daily placebo, all iron supplementation groups exhibited similar significantly lower odds of iron deficiency at 56 days, with odds ratios (ORs) of 0·62 (95% CI 0·56-0·68) for 30 mg daily, 0·63 (0·57-0·70) for 30 mg alternative days, 0·60 (0·55-0·66) for 60 mg daily, and 0·65 (0·59-0·72) for 60 mg on alternative days. For low ferritin, 0·70 (0·63-0·78) for 30 mg daily, 0·82 (0·74-0·91) for 30 mg on alternative days, 0·52 (0·47-0·57) for 60 mg daily, and 0·61 (0·55-0·68) for 60 mg on alternate days. For low haemoglobin, the ORs were 0·78 (0·67-0·91) for 30 mg daily, 0·80 (0·68-0·93) for 30 mg on alternative days, 0·75 (0·64-0·86) for 60 mg daily, and 0·77 (0·66-0·90) for 60 mg alternative days. Adverse events were reported in two participants-one event, an increase in migraines, was considered potentially related to the study intervention, but the other (a death) was deemed unrelated.

Interpretation: