OBJECTIVES:  With inter- and intra-patient variation in cost and health resource utilization, standard approaches to defining an episode of care (EOC) may perform poorly.  This study takes into account such variation and uses time-to-event analysis within an EOC framework to examine length and cost of care for vaso-occlusive crisis (VOC) in sickle cell disease (SCD). METHODS: Florida Medicaid administrative data from 2001-2005 were used to examine EOCs. Enrollees under the age of 65 with ≥1 inpatient or 2 outpatient claims ≥30 days apart containing a primary diagnosis of SCD (ICD-9 282.xx) and ≥6 months of continuous eligibility were included in the study.  Episodes began with the first VOC-related claim. Parametric survival analysis was used to calculate episode length as the number of days by which adjudicated payments returned to each patient’s pre-diagnosis average charge. Episode costs were calculated as the difference between pre- and post-diagnosis payments.  EOCs were calculated by subgroups according to age (pediatric and adult), gender, and presence of significant co-morbidity. RESULTS: Among 2,543 individuals included in the study, mean age was 14.4 years (standard deviation [SD]=11.9) and 48.2% were male.  Mean episode length was 11.6 days (95% confidence interval [CI]: 10.9-12.3). Pediatric patients had shorter episodes compared to adults (10.5 versus 16.4 days, respectively), but there were no differences by gender. The presence of acute chest syndrome secondary to VOC increased episode length to 13.4 days. The incremental cost of VOC was $327 (95% CI: $310-$343). Costs were slightly higher for males versus females and for adults versus pediatric patients. CONCLUSIONS:  Episode length as determined by parametric survival analysis was consistent with the clinical presentation of VOC. Our analysis suggests that cost may vary among patient groups with similar episode length.  Future work aims to quantify differences between standard and parameteric-based EOC approaches.