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

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 / Dissertation

2026

Publisher

University of Cape Town

Department

Department of Medicine

Faculty

Faculty of Health Sciences

Abstract

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.