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Management of iron deficiency anaemia in secondary care across England between 2012 and 2018: a real-world analysis of Hospital Episode Statistics
  1. Matthew James Brookes1,2,
  2. Angela Farr3,
  3. Ceri J Phillips3,
  4. Nigel John Trudgill4
  1. 1Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
  2. 2Research Institue, University of Wolverhampton Faculty of Science and Engineering, Wolverhampton, UK
  3. 3College of Human and Health Sciences, Swansea University, Swansea, West Glamorgan, UK
  4. 4Department of Gastroenterology, Sandwell General Hospital, West Bromwich, UK
  1. Correspondence to Professor Matthew James Brookes, Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton WV10 0QP, UK; m.j.brookes{at}


Objective Iron deficiency anaemia (IDA) occurs in 2%–5% of men and postmenopausal women in the developed world and, if left untreated, can significantly impair quality of life or decompensate chronic illnesses. Approximately 10% of men and postmenopausal women with IDA have underlying gastrointestinal malignancy. This study identifies trends in the management of IDA in secondary care in England.

Design/method The Hospital Episode Statistics database was used to analyse IDA-related hospital and outpatient admissions (elective and non-elective) in National Health Service England between April 2012 and March 2018. Outcome measures included rates of readmission, length of stay (LOS) and cost per admission.

Results Between 2012/2013 and 2017/2018, there was a 72% increase in hospital admissions for patients with a primary diagnosis of IDA and a 68% increase in hospital spells, with the number of cases being managed non-electively increasing by 58%. Non-electively managed patients had a longer LOS (3.10 vs 0.04 days, respectively) and increased rate of readmissions within 30 days (24.1% vs 6.6%) versus patients managed electively. Average day-case cost was £449 versus £1676 for non-elective admission. Across the 195 clinical commissioning groups (CCGs) in England, non-elective spells per 100 000 population demonstrated extensive and widening variability, ranging from 18 to 118 in 2017/2018 compared with 11–55 in 2012/2013.

Conclusion The current analysis highlights several opportunities to improve patient outcomes and reduce costs. There is an opportunity to improve day-case services by looking at the difference between CCGs and the variability in care and to reduce the number of non-elective admissions.

  • anemia
  • health service research
  • iron deficiency

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  • Correction notice This article has been corrected since it published Online First. The second author's name has been amended.

  • Contributors MJB and CJP developed the initial research question and project protocol and then contributed to data analysis and preparation of the manuscript. AF assisted with data analysis and preparation of the manuscript. NJT contributed to data analysis and interpretation and manuscript preparation. All authors contributed to the writing and preparation and approval of the final manuscript. All authors had access to all of the study data and can take responsibility for data integrity and the accuracy of analyses. AF and CJP conducted the statistical analysis. MJB undertook primary drafting of the paper, and all authors contributed to significant redrafting. MJB is the guarantor of the paper.

  • Funding Vifor Pharma UK Ltd funded unrestricted access to the Hospital Episode Statistics (HES) data through Harvey Walsh Ltd.

  • Competing interests Manuscript was produced with the support of data accessed through HES and funded by Vifor International. MJB: Vifor International funded expenses and honoraria associated with analysis and manuscript preparation. CJP: Vifor International funded expenses and honoraria associated with analysis and manuscript preparation. MJB, NT and CJP have previously received consultancy fees from Vifor.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. Data are accessed from HES data and are provided by the National Health Service Information Centre for Health and Social Care under a commercial reuse licence via Harvey Walsh Ltd.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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