Economic Burden for Adults With Sickle Cell Disease and Matched Controls in the United States: Retrospective Analysis of a Commercial Insurance Database

OBJECTIVES: To evaluate healthcare resource use (HCRU) and costs associated with sickle cell disease (SCD), a lifelong, inherited blood disorder with frequent complications, we compared commercially insured US adults with SCD versus matched controls without SCD.

METHODS: Patients and controls (matched 1:1 for age, gender, US region, and race) were retrospectively identified from the IBM^® MarketScan^® Commercial Database. Eligible patients were ≥18 years old with ≥3 inpatient or outpatient SCD diagnoses (ICD-10 codes D57.0–D57.219; D57.4–D57.819) during July-1-2016 to December-31-2019 (index-identification period) and enrollment ≥6-months pre-index and ≥12-months post-index. All-cause HCRU and costs were calculated per-patient-per-year (PPPY), costs inflated to 2020 US-dollars, and groups compared using ANOVA.

RESULTS: For 2792 patients and 2792 matched controls, mean (SD) age was 38.0 (13.2) years; 62% were female. Of the patients with SCD, 25.6% received hydroxyurea, 27.3% ≥1 blood transfusion, and 77.9% opioid pain medication during follow-up (mean[SD] 32.6[13.8] months). During 12-months’ post-index, for patients versus controls, mean (SD) PPPY number of inpatient hospitalizations was 0.8 (1.8) versus 0.1 (0.3), length-of-stay 4.3 (12.3) versus 0.2 (1.2) days, outpatient visits 21.1 (25.1) versus 8.8 (14.4), emergency-room visits 1.7 (4.0) versus 0.2 (0.8), and prescriptions 20.3 (23.0) versus 11.5 (19.1) (all P<0.0001). Mean (SD) costs PPPY were higher across categories (inpatient costs: $19,071[$48,377] versus $1153[$6847], outpatient including emergency-room: $17,327[$35,582] versus $3786[$12,151], pharmacy: $4807[$19,178] versus $1711[$8412]), giving total costs of $41,205 ($72,885) versus $6650 ($19,011) (all P<0.0001). Out-of-pocket (OOP) payments PPPY were $2496 ($2832) for patients versus $971 ($1574) for controls (P<0.0001).

CONCLUSIONS: Adults with SCD had substantially increased HCRU versus matched controls. Payer and OOP costs were higher across all categories, with total costs for the SCD cohort six-fold those of controls. This study excluded adults without commercial insurance, who may have higher burden; nevertheless, it highlights the substantial economic burden of adults with SCD enrolled in commercial insurance plans.