INCIDENT COMPLICATIONS AND TREATMENT USE IN SICKLE CELL DISEASE IN US COMMERCIAL AND MEDICARE-INSURED PATIENTS
Author(s)
Elnara Fazio-Eynullayeva, MA1, Brenna Brady, PhD2, Carolyn Lew, PhD2, Adam Wufsus, PhD1;
1Novo Nordisk Inc., Plainsboro, NJ, USA, 2Merative, Ann Arbor, MI, USA
1Novo Nordisk Inc., Plainsboro, NJ, USA, 2Merative, Ann Arbor, MI, USA
OBJECTIVES: This study assessed 12-month incidence of SCD-related complications, changes in complication incidence before versus after November 2019 (when newer SCD therapies became available), and incident use of maintenance and as-needed therapies among commercially or Medicare-insured US patients.
METHODS: Retrospective cohort study using the Merative™ MarketScan® Commercial and Medicare databases from October 1, 2015 to June 30, 2023. The index date was the first SCD diagnosis ≥12 months after the start of patient eligibility. Patients required 12-month baseline and follow-up periods around the index date. Incident complications were defined as new diagnosis in 12-month follow-up with no record in 12-month baseline. Analyses were stratified by age at index (<18, 18-30, 31-64, ≥65 years). Incidence proportions were calculated for the 12-month follow-up. Pre/post-Nov 2019 comparisons were descriptive.
RESULTS: 6,449 people (59.6% female, mean age 31.0 [SD 19.5] years, 30.0% <18, 21.7% 18-30, 43.9% 31-64, 4.4% ≥65) qualified. Most frequent incident conditions during 12-month follow-up were infections (45.6%), anemia (23.1%), cardiovascular (17.4%), vaso-occlusive pain (16.8%), and fever (15.8%). By age, fever incidence was highest in <18 (30.3%); vaso-occlusive pain (23.1%) and acute chest syndrome (11.5%) were highest in 18-30; chronic pain was highest in 31-64 (16.5%); nephropathy (34.9%), renal impairment/failure (31.1%), fatigue (27.6%) were highest in ≥65. Descriptive comparisons showed few changes in complication incidence after Nov 2019. Incident medication use during follow-up was: antibiotics 19.9%, opioids 19.0%, prescription NSAIDs 18.8%; disease-modifying therapy use was limited (blood transfusion 7.1%, hydroxyurea 5.3%, L-glutamine 0.6%), and uptake of newer therapies (crizanlizumab, voxelotor) was <1%.
CONCLUSIONS: Incident complications varied by age, with more febrile/infectious events in children and more chronic organ complications in older adults, consistent with a shift in clinical burden across the lifespan. No substantial change in complication incidence was observed after availability of newer therapies. Treatment remained predominantly symptomatic with low uptake of disease-modifying newer agents.
METHODS: Retrospective cohort study using the Merative™ MarketScan® Commercial and Medicare databases from October 1, 2015 to June 30, 2023. The index date was the first SCD diagnosis ≥12 months after the start of patient eligibility. Patients required 12-month baseline and follow-up periods around the index date. Incident complications were defined as new diagnosis in 12-month follow-up with no record in 12-month baseline. Analyses were stratified by age at index (<18, 18-30, 31-64, ≥65 years). Incidence proportions were calculated for the 12-month follow-up. Pre/post-Nov 2019 comparisons were descriptive.
RESULTS: 6,449 people (59.6% female, mean age 31.0 [SD 19.5] years, 30.0% <18, 21.7% 18-30, 43.9% 31-64, 4.4% ≥65) qualified. Most frequent incident conditions during 12-month follow-up were infections (45.6%), anemia (23.1%), cardiovascular (17.4%), vaso-occlusive pain (16.8%), and fever (15.8%). By age, fever incidence was highest in <18 (30.3%); vaso-occlusive pain (23.1%) and acute chest syndrome (11.5%) were highest in 18-30; chronic pain was highest in 31-64 (16.5%); nephropathy (34.9%), renal impairment/failure (31.1%), fatigue (27.6%) were highest in ≥65. Descriptive comparisons showed few changes in complication incidence after Nov 2019. Incident medication use during follow-up was: antibiotics 19.9%, opioids 19.0%, prescription NSAIDs 18.8%; disease-modifying therapy use was limited (blood transfusion 7.1%, hydroxyurea 5.3%, L-glutamine 0.6%), and uptake of newer therapies (crizanlizumab, voxelotor) was <1%.
CONCLUSIONS: Incident complications varied by age, with more febrile/infectious events in children and more chronic organ complications in older adults, consistent with a shift in clinical burden across the lifespan. No substantial change in complication incidence was observed after availability of newer therapies. Treatment remained predominantly symptomatic with low uptake of disease-modifying newer agents.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EPH212
Topic
Epidemiology & Public Health
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Rare & Orphan Diseases