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A descriptive study assessing the effectiveness of patient blood management initiatives at a tertiary level hospital in South Africa by comparing the utilisation of iron therapy (oral and intravenous) to packed red blood cell transfusions over a 10-Year period
Iron deficiency anaemia (IDA) remains a significant public health challenge in low- and middle-income countries (LMICs) like South Africa, where progress towards the World Health Assembly's 2030 target of reducing anaemia by 50% among women of reproductive age is insufficient. Patient Blood Manageme...
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| Format: | Thesis |
| Language: | English English |
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Department of Medicine
2026
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| _version_ | 1869483659761811456 |
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| access_status_str | Open Access |
| author | Corin, Chadwin Frederick |
| author2 | Louw, Vernon |
| author_browse | Corin, Chadwin Frederick Louw, Vernon |
| author_facet | Louw, Vernon Corin, Chadwin Frederick |
| author_sort | Corin, Chadwin Frederick |
| collection | Thesis |
| description | Iron deficiency anaemia (IDA) remains a significant public health challenge in low- and middle-income countries (LMICs) like South Africa, where progress towards the World Health Assembly's 2030 target of reducing anaemia by 50% among women of reproductive age is insufficient. Patient Blood Management (PBM) initiatives, implemented at Groote Schuur Hospital (GSH) in 2018, aimed especially to optimise red cell mass and reduce reliance on packed red blood cell (pRBC) transfusions through enhanced utilisation of iron therapies. This study evaluates PBM's effectiveness by analysing expenditure trends on oral and intravenous (IV) iron therapies compared to pRBC transfusions over the 2013–2022 period. Methods: This retrospective cohort study used GSH pharmacy and Western Cape Blood Service (WCBS) data, covering April 2013 to March 2023, segmented into pre-PBM (2013–2017) and post-PBM (2018–2022) periods. Expenditure on the available oral iron (Ferrous Sulphate tablets, Ferrous Gluconate syrup), IV iron (Iron Hydroxide Dextran), and pRBC transfusions was adjusted to 2022 constant USD values using South Africa's Consumer Price Index (CPI) and 2022 Purchasing Power Parity (PPP) factor of 7.23. Expenditure per 1 000 patient encounters and cost differentials per annum were calculated. Statistical analyses included Wilcoxon Rank-Sum, Mann-Kendall, Wilcoxon signed-rank tests, bootstrap methods (10 000 resamples) for 95% confidence intervals, sensitivity analyses excluding 2020 data and segmented interrupted time-series models. Results: Since the initiation of PBM initiatives, iron therapy utilisation increased, with median annual expenditure per 1 000 patient encounters rising by 74.4% for oral iron therapy (from $16 to $28; Wilcoxon p=0.056; 95% CI: $0 to $21), 302.2% for IV iron therapy (from $25 to $99; p=0.008; 95% CI: $29 to $145), and 222% for combined iron therapy (from $41 to $131; p=0.008; 95% CI: $40 to $162). In contrast, median annual expenditure per 1 000 patient encounters on pRBC rose by only 3.2% (from $7 270 to $7 499; Wilcoxon p=0.548; 95% CI: $- 665 to $1 474), below the 11.4% acquisition cost increase (Wilcoxon signed-rank p=0.652), 2 potentially indicating reduced transfusion reliance. Cost differentials per annum showed an additional $90 for combined iron therapy, offset by $600 in pRBC savings, yielding a net savings of $510 (R3 680) per 1 000 patient encounters, with potential annual savings exceeding $305 400 (R2 208 042) at GSH. Sensitivity analyses excluding 2020 data (due to potential confounding effects of the COVID19 pandemic) showed trends remained directionally consistent (p≤0.176). Conclusions: PBM increased iron therapy utilisation, reduced pRBC reliance, and achieved cost savings, positioning it as a more affordable strategy for IDA management in South Africa and LMICs. Clinical outcome studies are needed to further validate these findings. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/43364 |
| institution | University of Cape Town (South Africa) |
| language | English eng |
| last_indexed | 2026-07-01T04:02:31.255Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2026 |
| publishDateRange | 2026 |
| publishDateSort | 2026 |
| publisher | Department of Medicine |
| publisherStr | Department of Medicine |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/43364 A descriptive study assessing the effectiveness of patient blood management initiatives at a tertiary level hospital in South Africa by comparing the utilisation of iron therapy (oral and intravenous) to packed red blood cell transfusions over a 10-Year period Corin, Chadwin Frederick Louw, Vernon iron therapy red blood cell South Africa Iron deficiency anaemia (IDA) remains a significant public health challenge in low- and middle-income countries (LMICs) like South Africa, where progress towards the World Health Assembly's 2030 target of reducing anaemia by 50% among women of reproductive age is insufficient. Patient Blood Management (PBM) initiatives, implemented at Groote Schuur Hospital (GSH) in 2018, aimed especially to optimise red cell mass and reduce reliance on packed red blood cell (pRBC) transfusions through enhanced utilisation of iron therapies. This study evaluates PBM's effectiveness by analysing expenditure trends on oral and intravenous (IV) iron therapies compared to pRBC transfusions over the 2013–2022 period. Methods: This retrospective cohort study used GSH pharmacy and Western Cape Blood Service (WCBS) data, covering April 2013 to March 2023, segmented into pre-PBM (2013–2017) and post-PBM (2018–2022) periods. Expenditure on the available oral iron (Ferrous Sulphate tablets, Ferrous Gluconate syrup), IV iron (Iron Hydroxide Dextran), and pRBC transfusions was adjusted to 2022 constant USD values using South Africa's Consumer Price Index (CPI) and 2022 Purchasing Power Parity (PPP) factor of 7.23. Expenditure per 1 000 patient encounters and cost differentials per annum were calculated. Statistical analyses included Wilcoxon Rank-Sum, Mann-Kendall, Wilcoxon signed-rank tests, bootstrap methods (10 000 resamples) for 95% confidence intervals, sensitivity analyses excluding 2020 data and segmented interrupted time-series models. Results: Since the initiation of PBM initiatives, iron therapy utilisation increased, with median annual expenditure per 1 000 patient encounters rising by 74.4% for oral iron therapy (from $16 to $28; Wilcoxon p=0.056; 95% CI: $0 to $21), 302.2% for IV iron therapy (from $25 to $99; p=0.008; 95% CI: $29 to $145), and 222% for combined iron therapy (from $41 to $131; p=0.008; 95% CI: $40 to $162). In contrast, median annual expenditure per 1 000 patient encounters on pRBC rose by only 3.2% (from $7 270 to $7 499; Wilcoxon p=0.548; 95% CI: $- 665 to $1 474), below the 11.4% acquisition cost increase (Wilcoxon signed-rank p=0.652), 2 potentially indicating reduced transfusion reliance. Cost differentials per annum showed an additional $90 for combined iron therapy, offset by $600 in pRBC savings, yielding a net savings of $510 (R3 680) per 1 000 patient encounters, with potential annual savings exceeding $305 400 (R2 208 042) at GSH. Sensitivity analyses excluding 2020 data (due to potential confounding effects of the COVID19 pandemic) showed trends remained directionally consistent (p≤0.176). Conclusions: PBM increased iron therapy utilisation, reduced pRBC reliance, and achieved cost savings, positioning it as a more affordable strategy for IDA management in South Africa and LMICs. Clinical outcome studies are needed to further validate these findings. 2026-06-23T12:04:11Z 2026-06-23T12:04:11Z 2026 2026-06-23T11:52:37Z Thesis / Dissertation Masters MMed http://hdl.handle.net/11427/43364 en eng application/pdf Department of Medicine Faculty of Health Sciences University of Cape Town |
| spellingShingle | iron therapy red blood cell South Africa Corin, Chadwin Frederick A descriptive study assessing the effectiveness of patient blood management initiatives at a tertiary level hospital in South Africa by comparing the utilisation of iron therapy (oral and intravenous) to packed red blood cell transfusions over a 10-Year period |
| thesis_degree_str | Master's |
| title | A descriptive study assessing the effectiveness of patient blood management initiatives at a tertiary level hospital in South Africa by comparing the utilisation of iron therapy (oral and intravenous) to packed red blood cell transfusions over a 10-Year period |
| title_full | A descriptive study assessing the effectiveness of patient blood management initiatives at a tertiary level hospital in South Africa by comparing the utilisation of iron therapy (oral and intravenous) to packed red blood cell transfusions over a 10-Year period |
| title_fullStr | A descriptive study assessing the effectiveness of patient blood management initiatives at a tertiary level hospital in South Africa by comparing the utilisation of iron therapy (oral and intravenous) to packed red blood cell transfusions over a 10-Year period |
| title_full_unstemmed | A descriptive study assessing the effectiveness of patient blood management initiatives at a tertiary level hospital in South Africa by comparing the utilisation of iron therapy (oral and intravenous) to packed red blood cell transfusions over a 10-Year period |
| title_short | A descriptive study assessing the effectiveness of patient blood management initiatives at a tertiary level hospital in South Africa by comparing the utilisation of iron therapy (oral and intravenous) to packed red blood cell transfusions over a 10-Year period |
| title_sort | descriptive study assessing the effectiveness of patient blood management initiatives at a tertiary level hospital in south africa by comparing the utilisation of iron therapy oral and intravenous to packed red blood cell transfusions over a 10 year period |
| topic | iron therapy red blood cell South Africa |
| url | http://hdl.handle.net/11427/43364 |
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