All-Cause Health Care Resource Utilization in Individuals with Sickle Cell Disease

Introduction

Clinical manifestations of Sickle Cell Disease (SCD) range from frequent fatigue and anemia to severe complications involving multiple organs. We estimated all cause health care resource utilization in individuals with SCD as compared to individuals without SCD.

Methods

Data from the Truven multi-state Medicaid claims database were used for all analyses. Sample inclusion criteria was being enrolled in covered health plan from January 1, 2012 through December 31, 2012. A cohort of individuals with SCD was identified based on having at least one inpatient or two or more outpatient claims with ICD-9-CM codes for sickle-cell thalassemia without crisis (282.41), sickle-cell thalassemia with crisis (282.42), Sickle-cell disease, unspecified (282.60), Sickle-cell-S disease without crisis (282.61), Sickle-Cell-S disease with crisis (282.62), Sickle-cell-C disease without crisis (282.63), Sickle-cell-C disease with crisis (282.64), other sickle-cell disease without crisis (282.68), or other sickle-cell disease with crisis (282.69). From the continuously enrolled individuals, a cohort of individuals without SCD was identified by matching individuals with SCD one-to-one on age, gender, and ethnicity. Means and 95 percent confidence intervals were calculated for, number of hospitalizations, hospital days, long term care visits, long term care days, emergency room visits, and outpatient visits. Wilcoxon Mann-Whitney test was employed to assess differences in health care resource utilizations in individuals with and without SCD.

Results

Among 5,136,748 individuals covered in the study period, 8,652 individuals with SCD were identified and matched to 8,652 individuals without SCD. Majorities of the study sample were black (74%), female (54%), and under 24 years old (64%). Mean annual hospitalizations among individuals with SCD were 1.39 (95 percent C.I.: 1.3 to 1.4, <0.001) as compared to 0.10 (95 percent C.I.: 0.09 to 0.1, p<0.001) hospitalizations in persons without SCD. Mean annual outpatient visits in individuals with SCD were 24.7 (95 percent C.I.: 23.9 to 25.5, p<0.001) as compared to 14.18 (95 percent C.I.: 13.4 to 14.9, p<0.001) outpatient visits in persons without SCD, and, mean annual emergency room visits in individuals with SCD were 3.71 (95 percent C.I.: 3.5 to 3.9, p<0.001) as compared to 0.89 (95 percent C.I.: 0.8 to 0.9, p<0.001) emergency room visits in persons without SCD.

Conclusions

SCD was associated with higher annual hospitalizations, hospital days, outpatient visits and emergency room visits as compared to individuals without SCD.