Vaso-Occlusive Crises and Costs of Sickle Cell Disease in Patients With Commercial, Medicaid and Medicare Insurance - The Perspective of Private and Public Payers

Aim: To characterize vaso-occlusive crises (VOCs) and describe healthcare costs among commercially-insured, Medicaid-insured, and Medicare-insured patients with sickle cell disease (SCD). Materials and Methods: The IBM Truven Health MarketScan Commercial (2000-2018), Medicaid Analytic eXtract (2008–2014), and Medicare Research Identifiable Files (2012–2016) databases were used to identify patients with >=2 SCD diagnoses. Study measures were evaluated during a 12-month follow-up period, stratified by annual number of VOCs (i.e., 0, 1, and >=2). Results: Among 16,092 commercially-insured patients (mean age =36.7 years), 35.3% had 1+ VOCs. Mean annual total all-cause healthcare costs were $15,747, $27,194, and $64,555 for patients with 0, 1, and 2+ VOCs, respectively. Total all-cause healthcare costs were mainly driven by inpatient (0 VOC =31.0%, 1 VOC =53.1%, 2+ VOCs =65.4%) and SCD-related costs (0 VOC =56.4%, 1 VOC =78.4%, 2+ VOCs =93.9%). Among 18,287 Medicaid-insured patients (mean age =28.5 years, fee-for-service =50.2%), 63.9% had 1+ VOCs. Mean annual total all-cause healthcare costs were $16,750, $29,880, and $64,566 for patients with 0, 1, and 2+ VOCs, respectively. Inpatient costs (0 VOC =37.2%, 1 VOC =64.3%, 2+ VOCs =72.9%) and SCD-related costs (0 VOC =60.9%, 1 VOC =73.8%, 2+ VOCs =92.2%) accounted for a significant proportion of total all-cause healthcare costs. Among 15,431 Medicare-insured patients (mean age =48.2 years), 55.1% had 1+ VOCs. Mean annual total all-cause healthcare costs were $21,877, $29,250, and $58,308 for patients with 0, 1, and >=2 VOCs, respectively. Total all-cause healthcare costs were mainly driven by inpatient (0 VOC =47.9%, 1 VOC =54.9%, 2+ VOCs =67.5%) and SCD-related costs (0 VOC =74.9%, 1 VOC =84.4%, 2+ VOCs =95.3%). Conclusions: A high proportion of patients experienced VOCs across payers. Furthermore, inpatient and SCD-related costs accounted for a significant proportion of total all-cause healthcare costs, which increased with VOC frequency. Abstract source