National Coverage Analysis (NCA) View Public Comments

Serum Iron Studies (Addition of Restless Leg Syndrome as a Covered Indication)

Public Comments

Commenter Comment Information
Jones, Christopher Title: University Hospital Sleep-Wake Center
Organization: University of Utah
Date: 08/23/2006

I am the medical director of the University of Utah Sleep Cneter.

Iron supplementation has been of great benefit to my patients with RLS but only when the ferritin is below about 20-30 or the transferrin binding is below about 20%.

Inadequate iron stores for purposes of treating RLS is farily common in the elderly but most of the population has normal stores and some have occult iron overload (e.g. hemochromatosis). Unfortunately, empiric "blind" oral iron supplementation


Manthena, Prasanth Date: 08/22/2006

I strongly feel this is the wrong decision to make in terms of RLS and iron studies. As a sleep specialist who sees and has a large population of RLS patients, testing for ferritin and iron levels is routine in my and every other sleep clinic that I know. It guides treatment decisions now in terms of whether to look for other disorders and to go ahead with iron therapy and will likely do so into the future with the possible use of IV iron as a therapy for refractory RLS

Schriner, Robert Organization: Baptist Sleep Disorders Center
Date: 08/18/2006

Extensive review of the literature. Why did you not poll at least a group of sleep specialists to provide "expert opinion"?

Gladen, Herbert Date: 08/17/2006

The consensus of expert opinion is that iron studies will benefit a substantial number of patients with RLS. Since there is a substantial relationship, RLS can identify occult anemia, even if iron supplementation has not yet been shown in controlled trials to improve symptoms.

Thompson, Lowery Title: Physician
Organization: Neurology Consultants
Date: 08/17/2006

I treat patients with restless leg syndrome as part of my practice as a Neurologist and Sleep Medicine Physician. I am board certified in both specialities. Iron studies, specifically serum ferritin levels, will sometimes identify patients who can be treated with iron replacement therapy, avoiding the use of more expensive and risky medications. Since there is some risk of hemachromatosis with iron replacement, I would not be able to recommend iron withou an initial evaluation of