The Cost of Adrenal Insufficiency in England-Analysis of NHS HES Data

Despite steroid replacement therapy, patients with adrenal insufficiency (AI) experience excessive infections and related hospital admissions. However, data examining the evolution of admissions, healthcare resources utilisation and cost burden is sparce.

Analysis of National Hospital Episode Statistics (HES) data set which contains details of all admissions and outpatient appointments at NHS hospitals in England.

Spells spanning financial years 2018/19 to 2022/23, focusing on HES codes E27.1 (Primary Adrenocortical Insufficiency; PAI) [n = 57,125], E27.2 (Addisonian Crisis; AC) [n = 12,640] and E27.4 (Other and Unspecified AI; UAI) [n = 79,965] were analysed for admissions, main diagnosis, bed-days, costs, follow-up, and readmissions.

Over the study period, admissions for AC remained stable; admissions involving UAI increased, whereas PAI admissions reduced transiently during COVID-19. Mean length of stay for AC increased from 5.1 to 6.8 days (34%). Patients with primary pneumonia and AI had longer hospital stays than those without AI and were more likely to require critical care. Mean cost per hospital stay increased, rising 25% for AC since 2019/20, reaching £2959 per stay. 10% of patients had >1 non-elective readmission within 12 months. Endocrinologist follow-up was lower than expected. Centres treating > 225 spells/year reviewed 20-46% of AI patients within 26 weeks of admission, and only 46% with a main diagnosis of AC in 2022/23.

AI admissions have increased since 2018/19. Bed-days and cost for AC episodes have also risen. Patients with concomitant AI were more likely to have longer stays and be re-admitted. Endocrinology follow-up appears surprisingly low despite published guidelines.