The Economic Burden of End-Organ Damage Among Medicaid Patients with Sickle Cell Disease in the United States: A Population-Based Longitudinal Claims Study

Abstract

BACKGROUND: The management of sickle cell disease (SCD), an inherited, chronic, and multifaceted condition, is associated with considerable health care resource utilization (HRU) and costs, especially for Medicaid. Anemia affects most patients with SCD and correlates with end-organ damage (EOD), such as stroke, chronic kidney disease (CKD), end-stage renal disease (ESRD), and pulmonary hypertension (PH). Limited research has been conducted to quantify the economic burden of EOD among patients with SCD. OBJECTIVE: To estimate the effect of EOD on HRU and direct costs and productivity loss incurred by patients with SCD on Medicaid. What this study addsSCD management strategies that potentially reduce the risk of EOD offer clinical and economic value to patients and society.

Cost analysis of acute care resource utilization among individuals with sickle cell disease in a middle-income country

“…Chronic end-organ damage can significantly increase the costs associated with the treatment in SCD and in our analysis, acute complications of end-organ damage represented the highest costs during hospitalizations. Although conducted in a LMIC country, our results correlate and are corroborated by published data among adults in the United States insured under government Medicaid plans showing high costs associated with end-organ damage [ 18 ]. Furthermore, our microcosting analysis reveals that pharmacy costs, housing, and personnel time accounted for most of the cost related to ED and inpatient visits in our analysis.…”

How Free Is Free Health Care? An Assessment of Universal Health Coverage Among Jamaicans with Sickle Cell Disease

“…Similarly, among 10,784 subjects in the United States, SCD patients with end-organ damage had ''higher all-cause health care costs and more inpatient days, emergency department visits, outpatient visits, laboratory tests, and outpatient pharmacy claims'' than those without; and costs were higher for those with multiple end-organ damage. 29 We also aimed to compare subjects who were admitted to public and private hospitals. Persons from overcrowded households, a proxy for low socioeconomic status, were more likely to be admitted to public hospitals.…”

Medical and Non-medical Costs of Sickle Cell Disease and Treatments from a US Perspective: A Systematic Review and Landscape Analysis

“…1) . The majority of studies (80%) were retrospective cohort studies [22-24, 26-29, 31-35, 37-44, 46-50, 53, 54, 56, 58-61], with a similar proportion of studies that explored patients of all ages (40%) [22,23,31,32,34,35,37,38,41,43,43,52,[58][59][60][61] and under 18 years of age (37%) [33, 36, 39, 40, 44-46, 49-51, 53-55, 57]. Data sources were varied.…”

“…There was an equal split in the pattern for reported units of analysis, with per patient (47%) [22-24, 29, 31, 32, 35, 42, 43, 47-49, 54-56, 58-61] and per hospital admission (50%) [25-28, 30, 33, 34, 36-42, 44, 46, 50, 51, 53, 57] as the most frequently reported units. Inpatient costs [22,23,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61] were the most frequently reported cost component, followed by outpatient [23, 24, 31, 32, 35, 39, 42-44, 47, 48, 51, 54, 56, 58-61], pharmacy [22-24, 31, 32, 35, 42, 43, 47, 48, 56, 58-61], and ED costs [22,23,29,31,35,…”

“…Medical costs for acute complications ranged from $2616 [44] to $93,868 [42], represented by depression-and stroke-related admissions, respectively. Stroke cost estimates are reported with a wide range, between $56,316 [43] and $93,868 [42] per admission. Myocardial infarction admission costs were slightly lower than stroke, at $53,458 per visit [42].…”