OBJECTIVES: All cause health care resource utilization in individuals with Sickle Cell Disease (SCD) and Sickle Cell Crisis (SCC) compared to individuals with SCD without SCC. METHODS: A multi-state Medicaid claims database was used for all analyses.  Sample inclusion criteria was being continuously enrolled in covered health plan from January 1, 2012 through December 31, 2012. There was no explicit exclusion criterion.  SCD was identified based on having at least one inpatient claim or having two or more outpatient claims with ICD-9-CM codes for sickle-cell thalassemia with or without crisis or SCD with or without crisis.  SCC was identified based on at least one claim with ICD-9-CM codes for crisis.  Means and 95 percent confidence intervals were calculated for hospitalizations, hospital days, emergency room visits, and outpatient visits.  Wilcoxon Mann-Whitney tests were employed to assess differences in health care resource utilization among individuals with SCC and those without SCC. RESULTS: Of 8,652 individuals identified with SCD, 4,972 had SCC over the study interval.  Mean annual hospitalizations among individuals with crisis, 2.17 (95% C.I.: 2.08 to 2.25, p<0.001) was higher than those without crisis, 0.34 (95% C.I.: 0.31 to 0.38, p<0.001).  Mean annual hospital days in individuals with SCC, 10.98 (95% C.I.: 10.41 to 11.54, p<0.001) were more than six times higher than among those without crisis, 1.72 (95% C.I.: 1.47 to 1.98, p<0.001).  Mean outpatient visits in individuals with crisis, 26.12 (95% C.I.: 25.14 to 27.10, p<0.001) were more than those without crisis 22.91(95% C.I.: 21.46 to 24.35, p<0.001), and mean annual emergency room visits among individuals with crisis, 5.28 (95 percent C.I.: 4.97 to 5.60, p<0.001) were more than 3 times higher than individuals without crisis, 1.58 (95% C.I.: 1.45 to 1.72, p<0.001). CONCLUSIONS: SCC in individuals with SCD was associated with much higher health care resource utilization.