Improved health care utilization and costs in transplanted versus non-transplanted adults with sickle cell disease

• Published in: PloS one Vol. 15; no. 2; p. e0229710
• Main Authors: Saraf, Santosh L, Ghimire, Krishna, Patel, Pritesh, Sweiss, Karen, Gowhari, Michel, Molokie, Robert E, Gordeuk, Victor R, Rondelli, Damiano
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 26-02-2020; Public Library of Science (PLoS)
• Subjects: Adults; Antibodies; Biology and Life Sciences; Blood; Comparative analysis; Complications; Diseases; Economic aspects; Emergency medical care; Emergency medical services; Engineering and Technology; Erythrocytes; Health aspects; Health care; Health care costs; Health care expenditures; Health care policy; Health care reform; Health services utilization; Hematology; Hematopoietic stem cell transplantation; Hematopoietic stem cells; Hemoglobin; Histocompatibility antigen HLA; Hospital patients; Hospitals; Medical care quality; Medical care utilization; Medical economics; Medicine; Medicine and Health Sciences; Morbidity; Oncology; Patients; Pharmacy; Regression analysis; Sickle cell anemia; Sickle cell disease; Stem cell transplantation; Stem cells; Surgery; Therapy; Transplantation; Transplants & implants; Utilization; United States > US; Illinois; Chicago Illinois
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0229710

Patients with sickle cell disease (SCD) have access to fewer health care resources and therapies compared to other diseases, which contributes to increased morbidity and health care utilization. We compared health care utilization (inpatient hospital days, emergency care visits) and health care-related costs between SCD adults that underwent hematopoietic stem cell transplantation (HSCT) using a nonmyeloblative conditioning regimen versus those referred for HSCT but did not proceed due to lack of an HLA-matched sibling donor, denial by insurance, red blood cell antibodies to the potential donor, or declining further evaluation. Between 8/2011 and 4/2016, 83 SCD patients were referred for allogeneic HSCT and 16 underwent the procedure. The HSCT and non-HSCT groups were similar by age, sex, prior SCD-related therapy and complications. Compared to pre HSCT, significantly fewer inpatient hospital days (median of 1 versus 22 days, P = 0.003) and emergency care visits (median of 1 versus 4 visits, P = 0.04) were observed by the 2nd year post-HSCT. Similar results were observed in comparison to the standard-of-care group (median of 1 versus 12 hospital days, P = 0.002; median of 1 versus 3 emergency visits, P = 0.03). Lower health care costs were observed by the 2nd year post-HSCT (median of $16,281 versus $64,634 pre-HSCT (P = 0.01) and versus $54,082 in the standard-of-care group (P = 0.05). A median reduction of -$20,833/patient/year (IQR, -$67,078-+$4,442/patient/year) in health care costs compared to pre-HSCT was observed in the 2nd year post-HSCT. In conclusion, allogeneic HSCT leads to improvements in health care utilization and costs compared to standard-of-care therapy in high-risk SCD adults.