Economic burden of sickle cell disease in the United States: a retrospective analysis of a commercial insurance database

Abstract

Aim: To evaluate healthcare resource utilization (HCRU) and costs for US commercially insured adult and pediatric patients with sickle cell disease (SCD) and matched non-SCD cohorts. Materials & methods: Patients with ≥3 SCD diagnosis codes (D57.0–D57.219; D57.4–D57.819) from July 2016 to December 2020 were identified from the IBMR○ MarketScanR○ Commercial database. The earliest SCD diagnosis was defined as the index date. Non-SCD control patients were matched 1:1 on age, gender and region. Continuous 6-month baseline and ≥12-month follow-up coverage was required. Follow-up HCRU and costs (2020 USD) were calculated per patient per year. Pediatric (<18 years) and adult (≥18 years) patients were analyzed separately. Results: For 1299 pediatric patients with SCD and matched controls, mean (SD) age was 10.0 (4.8) years and 51% were female; mean (SD) follow-up was 34.3 (14.4) months. In the first 12 months, pediatric patients with SCD had higher HCRU (hospitalizations: 0.6 vs 0.01; hospital length of stay: 2.4 vs 0.05 days; outpatient visits: 13.4 vs 6.0; office visits: 6.9 vs 4.7; prescriptions: 12.8 vs 3.8) and mean total costs ($31,445 vs $2844), mainly due to hospitalizations ($15,195 vs $477) and outpatient visits ($12,746 vs $1758), versus controls (all p < 0.0001). For 2792 adults with SCD and matched controls, mean (SD) age was 38.0 (13.2) years and 62% were female; mean (SD) follow-up was 31.8 (13.7) months. Adults with SCD had higher per-patient per-year HCRU (hospitalizations: 0.8 vs 0.06; hospital length of stay: 4.3 vs 0.2 days; outpatient visits: 20.9 vs 9.3; office visits: 10.4 vs 6.9; prescriptions: 20.5 vs 11.7) and mean total costs ($42,550 vs $7522), also due to hospitalizations ($20,056 vs $1326) and outpatient visits ($17,508 vs $4301), versus controls (all p < 0.0001). Conclusion: The economic burden of SCD among pediatric and adult patients is substantial with increased HCRU and costs compared with matched controls. Better treatments for SCD could reduce the economic burden for patients, as well as payers. Plain language summary What was the aim of this research? The aim of this study was to compare the healthcare usage and costs of commercially insured people with and without sickle cell disease (SCD). How was the research carried out? Using commercial insurance claims data from July 2016 to December 2020, patients with SCD were each matched to someone without SCD who was the same age, gender, and living in the same region. Healthcare resource usage and costs from the first SCD diagnosis between July 2016 and December 2019, or from a random date during the same period for those without SCD, were calculated per patient per year. Pediatric (<18 years) and adult (≥18 years) patients were analyzed separately. What were the results? Pediatric patients with SCD had significantly more healthcare usage compared with those without SCD. In the first 12 months of follow-up, patients with SCD had more hospitalizations (39.3-fold), ER visits (6.3-fold), outpatient visits (2.2-fold), and prescriptions (3.4-fold). Healthcare costs were also higher for patients with versus without SCD ($31,445 vs $2844), primarily due to hospitalizations ($15,195 vs $477) and outpatient visits ($12,746 vs $1758). Adult patients with SCD also had higher healthcare usage compared with those without SCD, with more hospitalizations (14.4-fold), ER visits (7.2-fold), and twice as many outpatient visits and prescriptions during follow-up. Their higher healthcare costs ($42,550 vs $7522) were also due to hospitalizations ($20,056 vs $1326) and outpatient visits ($17,508 vs $4301). What do the results of the study mean? Commercially insured pediatric and adult patients with SCD in the US have substantially higher healthcare resource utilization and costs compared with matched controls. Better treatments for SCD could reduce the economic burden for both patients and payers.