Economic and Clinical Burden of Managing Sickle Cell Disease with Recurrent Vaso-Occlusive Crises in the United States

• Published in: Advances in therapy Vol. 40; no. 8; pp. 3543 - 3558
• Main Authors: Udeze, Chuka, Evans, Kristin A., Yang, Yoojung, Lillehaugen, Timothy, Manjelievskaia, Janna, Mujumdar, Urvi, Li, Nanxin, Andemariam, Biree
• Format: Journal Article
• Language: English
• Published: Cheshire Springer Healthcare 01-08-2023
• Subjects: Anemia, Sickle Cell - complications; Anemia, Sickle Cell - therapy; Cardiology; Data Collection; Endocrinology; Health Care Costs; Humans; Inpatients; Internal Medicine; Medicine; Medicine & Public Health; Oncology; Original Research; Patient Acceptance of Health Care; Pharmacology/Toxicology; Retrospective Studies; Rheumatology; United States; United States; Vaso-occlusive crisis; Healthcare costs; Costs and cost analysis; Healthcare economics and organizations; Medicaid; Sickle cell disease; Clinical decision-making
• ISSN: 0741-238X; 1865-8652; 1865-8652
• DOI: 10.1007/s12325-023-02545-7

Introduction
The aim of this study was to describe the clinical complications, treatment use, healthcare resource utilization (HCRU), and costs among patients with sickle cell disease (SCD) with recurrent vaso-occlusive crises (VOCs) in the US.
Methods
Merative MarketScan Databases were used to identify patients with SCD with recurrent VOCs from March 1, 2010, to March 1, 2019. Inclusion criteria were ≥ 1 inpatient or  ≥ 2 outpatient claims for SCD and ≥ 2 VOCs per year in any 2 consecutive years after the first qualifying SCD diagnosis. Individuals without SCD in these databases were used as matched controls. Patients were followed for ≥ 12 months, from their second VOC in the 2nd year (index date) to the earliest of inpatient death, end of continuous enrollment in medical/pharmacy benefits, or March 1, 2020. Outcomes were assessed during follow-up.
Results
In total, 3420 patients with SCD with recurrent VOCs and 16,722 matched controls were identified. Patients with SCD with recurrent VOCs had a mean of 5.0 VOCs (standard deviation [SD] = 6.0), 2.7 inpatient admissions (SD 2.9), and 5.0 emergency department visits (SD 8.0) per patient per year during follow-up. Compared to matched controls, patients with SCD with recurrent VOCs incurred higher annual ($67,282 vs. $4134) and lifetime ($3.8 million vs. $229,000 over 50 years) healthcare costs.
Conclusion
Patients with SCD with recurrent VOCs experience substantial clinical and economic burden driven by inpatient costs and frequent VOCs. There is a major unmet need for treatments that alleviate or eliminate clinical complications, including VOCs, and reduce healthcare costs in this patient population.