However, these results were reported as median and interquartile range and therefore could not be assessed for imprecision. Similar to IV iron the committee agreed that due to the potential to cause toxicity using iron therapy, there needs to be good evidence that a patient is iron deficient prior to being given oral iron. In addition, the committee agreed that the cause of iron deficiency should be fully investigated to ensure that other causes could be elucidated before starting replacement therapy. The committee also noted that patient compliance with oral iron tended to be poor in clinical practice due to unpleasant gastrointestinal side effects. Overall, the committee agreed that there did not appear to be a benefit of oral iron in people with HFREF and iron deficiency and therefore decided not to make a recommendation regarding oral iron. Trade-off between net clinical effects and costs No previously published economic evaluations were identified that considered oral iron supplementation compared to no supplementation or IV iron supplementation compared to oral iron supplementation in people with HF and iron deficiency. One relevant economic evaluation was included in this review that considered IV iron supplementation compared to no iron supplementation for people with HF and iron deficiency. This was based on the FAIR-HF trial included in the clinical review. This economic evaluation found that IV iron supplementation increased costs and improved health (increased QALYs) compared with no iron supplementation with an incremental cost- effectiveness ratio of 3,977 per QALY gained. The probability that IV iron is cost effective at the 20,000 per QALY threshold was around 99%. The analysis only reflected the effectiveness evidence from 1 RCT of 4 included in the clinical review and was assessed as directly applicable with potentially serious limitations. 