{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T07:17:39Z","timestamp":1767856659078,"version":"3.49.0"},"reference-count":13,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T00:00:00Z","timestamp":1738627200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Analysis of National Hospital Episode Statistics (HES) data set which contains details of all admissions and outpatient appointments at NHS hospitals in England.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and Measurements<\/jats:title><jats:p>Spells spanning financial years 2018\/19 to 2022\/23, focusing on HES codes E27.1 (Primary Adrenocortical Insufficiency; PAI) [<jats:italic>n<\/jats:italic>\u2009=\u200957,125], E27.2 (Addisonian Crisis; AC) [<jats:italic>n<\/jats:italic>\u2009=\u200912,640] and E27.4 (Other and Unspecified AI; UAI) [<jats:italic>n<\/jats:italic>\u2009=\u200979,965] were analysed for admissions, main diagnosis, bed\u2010days, costs, follow\u2010up, and readmissions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Over the study period, admissions for AC remained stable; admissions involving UAI increased, whereas PAI admissions reduced transiently during COVID\u201019. 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 \u00a32959 per stay. 10% of patients had &gt;1 non\u2010elective readmission within 12 months. Endocrinologist follow\u2010up was lower than expected. Centres treating\u2009&gt;\u2009225 spells\/year reviewed 20\u221246% of AI patients within 26 weeks of admission, and only 46% with a main diagnosis of AC in 2022\/23.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>AI admissions have increased since 2018\/19. Bed\u2010days and cost for AC episodes have also risen. Patients with concomitant AI were more likely to have longer stays and be re\u2010admitted. Endocrinology follow\u2010up appears surprisingly low despite published guidelines.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.15207","type":"journal-article","created":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T13:29:41Z","timestamp":1738675781000},"page":"611-617","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Cost of Adrenal Insufficiency in England\u2014Analysis of NHS HES Data"],"prefix":"10.1111","volume":"102","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6730-6109","authenticated-orcid":false,"given":"Robert D.","family":"Murray","sequence":"first","affiliation":[{"name":"Department of Endocrinology Leeds Centre for Diabetes &amp; Endocrinology, Leeds Teaching Hospitals NHS Trust Leeds UK"},{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM) University of Leeds Leeds UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0293-7070","authenticated-orcid":false,"given":"Leonardo","family":"Ruiz\u2010Casas","sequence":"additional","affiliation":[{"name":"Global Market Access Advanz Pharma London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Beckett","sequence":"additional","affiliation":[{"name":"CSL (CompuFile Systems Ltd) Godalming UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juergen","family":"Polifka","sequence":"additional","affiliation":[{"name":"Global Market Access Advanz Pharma London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandrine","family":"Cure","sequence":"additional","affiliation":[{"name":"Global Medical Affairs Advanz Pharma London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beate","family":"Ritz","sequence":"additional","affiliation":[{"name":"Global Medical Affairs Advanz Pharma London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Wass","sequence":"additional","affiliation":[{"name":"Oxford Centre for Diabetes, Endocrinology and Metabolism University of Oxford Oxford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,2,4]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2016-2221"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2009.03596.x"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2014-3191"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/cen.13608"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.7861\/clinmed.2019-0324"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1530\/EC-16-0054"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/cen.13060"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1210\/js.2016-1064"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-19-0469"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2013.08.651"},{"key":"e_1_2_8_12_1","first-page":"1","article-title":"Adrenal Insufficiency: Investigating Prevalence and Healthcare Utilization Using Administrative Data","volume":"6","author":"Sekhon S.","year":"2021","journal-title":"Adrenal Insufficiency: Investigating Prevalence and Healthcare Utilization Using Administrative Data"},{"key":"e_1_2_8_13_1","unstructured":"The Health and Social Care Information Centre. Methodology to Create Provider and CIP Spells from HES APC Data https:\/\/webarchive.nationalarchives.gov.uk\/ukgwa\/20180307232845tf_\/."},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2023.1252577"}],"container-title":["Clinical Endocrinology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cen.15207","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T12:31:34Z","timestamp":1746189094000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/cen.15207"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,4]]},"references-count":13,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,6]]}},"alternative-id":["10.1111\/cen.15207"],"URL":"https:\/\/doi.org\/10.1111\/cen.15207","archive":["Portico"],"relation":{},"ISSN":["0300-0664","1365-2265"],"issn-type":[{"value":"0300-0664","type":"print"},{"value":"1365-2265","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,4]]},"assertion":[{"value":"2024-07-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-19","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}