Socioeconomic dispersion of publicly funded intravenous iron therapies for iron deficiency during pregnancy in Australia: a retrospective population-based cohort study

Objectives Iron deficiency in pregnancy poses significant risks to maternal and fetal health, which are exacerbated by socioeconomic disadvantage. The objective of this study was to assess the socioeconomic distribution of publicly funded intravenous iron therapies for iron deficiency in pregnant women, evaluating the capacity of public policy to promote equal access to medications. Study type Retrospective, population-based cohort study. Methods The Maternity1000 dataset was used to analyse access to and public expenditure on intravenous iron therapies dispensed via the Pharmaceutical Benefits Scheme (PBS) during 176,036 pregnancies (July 2015 to June 2018) in Queensland, Australia; stratified by socioeconomic status. Inequalities were assessed through benefit incidence analyses and concentration indices (C). Results Diagnosed iron deficiency was more common among women living in less disadvantaged areas (Q5: 7.58% vs Q1: 5.06%). Access to ferric carboxymaltose showed no significant socioeconomic-related inequality overall (Coverall = 0.004; P = 0.594). However, annual concentration indices increased incrementally over the study timeframe, with a small shift in the distribution of access towards women living in less disadvantaged areas in 2017/18 (C2017/18 = 0.038; P < 0.001). In contrast, access to iron polymaltose showed no evidence of socioeconomic inequality (Coverall = −0.024; P = 0.358). Government expenditure on iron polymaltose was consistently concentrated among more disadvantaged areas; reflecting its lower cost and reduced government contribution for less disadvantaged women. Government expenditure on ferric carboxymaltose was evenly distributed overall (Coverall = −0.011; P = 0.130), with annual stratification showing public expenditure became increasingly concentrated among less disadvantaged areas in 2017/18 (C2017/18 = 0.027; P = 0.011). Conclusions The PBS plays an important role in supporting intravenous iron access in pregnancy, although minor socioeconomic disparities may be emerging for newer, higher-cost formulations. Ongoing monitoring is needed to ensure rising public expenditure delivers equitable, high-value maternal care without deepening existing inequalities.