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

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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 IBM ® MarketScan ® 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.

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