Vaso-occlusive crises and costs of sickle cell disease in patients with commercial, Medicaid, and Medicare insurance – the perspective of private and public payers

Abstract

Aim

To characterize vaso-occlusive crises (VOCs) and describe healthcare costs among commercially-insured, Medicaid-insured, and Medicare-insured patients with sickle cell disease (SCD).

Materials and methods

The IBM Truven Health MarketScan Commercial (2000–2018), Medicaid Analytic eXtract (2008–2014), and Medicare Research Identifiable Files (2012–2016) databases were used to identify patients with ≥2 SCD diagnoses. Study measures were evaluated during a 12-month follow-up period, stratified by annual number of VOCs (i.e. 0, 1, and ≥2).

Results

Among 16,092 commercially-insured patients (mean age = 36.7 years), 35.3% had 1+ VOCs. Mean annual total all-cause healthcare costs were $15,747, $27,194, and $64,555 for patients with 0, 1, and 2+ VOCs, respectively. Total all-cause healthcare costs were mainly driven by inpatient (0 VOC = 31.0%, 1 VOC = 53.1%, 2+ VOCs = 65.4%) and SCD-related costs (0 VOC = 56.4%, 1 VOC = 78.4%, 2+ VOCs = 93.9%). Among 18,287 Medicaid-insured patients (mean age = 28.5 years, fee-for-service = 50.2%), 63.9% had 1+ VOCs. Mean annual total all-cause healthcare costs were $16,750, $29,880, and $64,566 for patients with 0, 1, and 2+ VOCs, respectively. Inpatient costs (0 VOC = 37.2%, 1 VOC = 64.3%, 2+ VOCs = 72.9%) and SCD-related costs (0 VOC = 60.9%, 1 VOC = 73.8%, 2+ VOCs = 92.2%) accounted for a significant proportion of total all-cause healthcare costs. Among 15,431 Medicare-insured patients (mean age = 48.2 years), 55.1% had 1+ VOCs. Mean annual total all-cause healthcare costs were $21,877, $29,250, and $58,308 for patients with 0, 1, and ≥2 VOCs, respectively. Total all-cause healthcare costs were mainly driven by inpatient (0 VOC = 47.9%, 1 VOC = 54.9%, 2+ VOCs = 67.5%) and SCD-related costs (0 VOC = 74.9%, 1 VOC = 84.4%, 2+ VOCs = 95.3%).

Limitations

VOCs managed at home were not captured. Analyses were descriptive in an observational setting; thus, no causal relationships can be inferred.

Conclusions

A high proportion of patients experienced VOCs across payers. Furthermore, inpatient and SCD-related costs accounted for a significant proportion of total all-cause healthcare costs, which increased with VOC frequency.

Keywords:

• Vaso-occlusive crisis
• sickle cell disease
• healthcare costs
• real world
• Medicaid
• Medicare
• payer

JEL classification codes:

• H51
• I11
• I15
• I10

Transparency

Declaration of funding

This study was funded by Novartis Pharmaceuticals Corporation.

Declaration of financial/other interests

NS received grants and personal fees from Novartis, grants and personal fees from GBT, personal fees from Alexion, and personal fees from CSL Behring, outside the submitted work. As an employee of Novartis, MB received salary, and dividends from Novartis, and owns Novartis stocks. DLV, PGS, ES, MD, and AG are employees of Analysis Group, Inc., which provided paid consulting services to Novartis for the conduct of the present study. GP has nothing to disclose. AK, VS, and MKS are employees of Novartis Healthcare Pvt. Ltd. LX has nothing to disclose.

JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

Medical writing assistance was provided by Samuel Rochette, who is an employee of Analysis Group, Inc.

Data availability statement

Data used for this study are from IBM (used under license for the current study) and Centers for Medicare and Medicaid Services (CMS; administrative permissions were required to access the raw data under a data user agreement requesting HIPAA waiver and IRB exemption). Therefore, restrictions apply to the availability of these data, which are not publicly available.

Previous presentation

Part of the material in this manuscript was presented at the AMCP 2020 meeting held 21–24 April in Houston, TX, and at the ASH 2019 annual meeting held 7–10 December 2019 in Orlando, FL.