OBJECTIVES: To describe all-cause healthcare resource utilization (HCRU) and costs during 1-year pre- and post- first crisis among adult sickle cell (SC) patients.

METHODS: This study was conducted in two US health plan claims databases, Truven Medicaid and Truven Commercial & Medicare Supplemental (“Commercial”). Eligible patients had ≥2 SC claims, ≥1 SC crisis claims during study period (2009-2015 for Medicaid and 2009-2016 for Commercial). Patients were aged ≥18y at index (i.e., first crisis), continuously enrolled during 1-year pre- and post-index (post-index includes indexed crisis), and “crisis-free” during 1-year pre-index period. Crises were defined as emergency room (ER) or hospitalization claims with SC crisis diagnosis codes. Costs were estimated in patients with fee-for-service insurance and adjusted for 2017 inflation. McNemar’s and Wilcoxon signed-rank tests were used for comparing pre- and post-index HCRU and costs.

RESULTS: Study population included 1,104 (fee-for-service:460) and 1,583 (fee-for-service: 1,234) patients in Medicaid and Commercial, respectively. Mean (SD) age was 30.6y (11.7) in Medicaid and 38.0y (14.1) in Commercial. Regarding pre- and post-index all-cause HCRU, ER use increased by 32% in Medicaid (52% to 84%, p<0.0001) and 38% in Commercial (30% to 68%, p<0.0001). Hospital admissions increased by 53% (16% to 69%, p<0.0001) in Medicaid, and 56% (13% to 69%, p<0.0001) in Commercial. Regarding pre- and post-index all-cause healthcare costs, mean total costs increased by $35,976 in Medicaid ($15,355 to $51,331, p<0.0001); $28,410 in Commercial ($16,826 to $45,236, p<0.0001). Mean hospital admission costs increased by $23,500 ($4,480 to $27,980, p<0.0001) in Medicaid; $22,954 in Commercial ($4,965 to $27,919, p<0.0001). Mean ER costs increased by $2,356 ($1,284 to $3,640, p<0.0001) in Medicaid; $2,179 in Commercial ($1,030 to $3,209, p<0.0001).

CONCLUSIONS: We observed a significant increase in HCRU during post-crisis period among SC patients resulting in substantial increases in costs. Thus, effective interventions to prevent/treat SC crises are warranted.