OBJECTIVES

: Patients with sickle cell disease (SCD), an inherited disorder characterized by polymerization of hemoglobin S and red blood cell (RBC) sickling, are at increased risk for stroke. Chronic RBC transfusions (CRBT) are recommended for both primary and secondary prevention of stroke in patients with SCD. However, CRBT is associated with many risks, including iron overload, allo/autoimmunization, hemolysis, and infections. These require treatment and monitoring, further driving the health and economic burden. The objective of this study was to quantify the total economic burden of CRBT among patients with SCD.

METHODS

: A retrospective observational study using the IBM MarketScan Commercial (4/1/2013 to 3/30/2018) and Medicaid Claims (1/1/2013 to 12/31/2017) datasets included patients with SCD (≥3 non-diagnostic ICD9/ICD10 codes of SCD) and CRBT (≥8 transfusions within 1 year). Transfusion frequency, units of blood transfused, iron chelation therapy use, and costs were summarized descriptively.

RESULTS

: A total of 829 patients (Medicaid: 581; Commercial: 248) with SCD who received CRBT were identified. Patients received a mean (SD) of 10.80 (0.66) transfusions PPPY on Medicaid vs 12.19 (2.15) on Commercial plans, which required 16.29 and 21.04 units of blood PPPY, respectively. Though not significant, adult patients on Commercial plans had more transfusions (patients aged 18-30 years: 13.7 transfusions PPPY, using 22.28 units; patients aged 31-44 years: 12.31, using 31.68 units) compared with those who were on Medicaid. During an average of 2.56/3.46 (Medicaid/Commercial plans) years of follow up, 87.9%/75.8% of patients received iron chelation, costing $56,058/$76,990 PPPY. The total annualized transfusion-related cost, including transfusion, iron chelation therapy, and liver MRI, was $60,863/$97,709 PPPY for Medicaid/Commercial plans, respectively.

CONCLUSIONS

: The total transfusion-related costs among patients with SCD receiving CRBT are substantially beyond the cost of just blood transfusion. New drug therapies improving hemoglobin level may reduce the frequency of RBC transfusions and can offer both clinical and economic value.