Healthcare resource utilization in persons with sickle cell disease

Jigar R Rajpura, Purdue University

Abstract

The objectives of this study were to determine prevalence of sickle cell disease (SCD) in a Medicaid population, to determine all-cause health care resource utilization and incremental health care resource utilization associated with SCD. An observational database analysis was conducted using information from a large administrative claims database. Individuals continuously enrolled in a tracked health plan during the period from January 1, 2012 through December 31, 2012, were eligible for inclusion in the sample for determination of SCD prevalence. To select the sample for estimating all-cause resource utilization and incremental resource utilization associated with SCD, administrative claims and enrollment records from January 1, 2012 through December 31, 2012 were examined to select 8,652 individuals with SCD based on ICD-9-CM diagnosis codes. SCD patients were linked one-to-one on age, gender, and race with individuals without SCD resulting in 8,652 persons in the comparison group and a total of 17,304 persons in the overall sample. The number of individuals enrolled anytime during the period from January 1, 2012 through December 31, 2012 that had a diagnosis for SCD, were identified and divided by the total population of covered individuals during the same one year period to calculate prevalence of SCD. All-cause heath care resource utilization among individuals with SCD were estimated by counting the total number of hospitalizations, hospital days, outpatient visits, and emergency room visits. Incremental health care resource utilization associated with SCD was estimated using regression models adjusting for risk factors including age, gender, and race, comorbidities, and Medicare coverage status. The prevalence of SCD was one in 594 persons or 1,684 cases per million people. Ninety-five percent confidence interval was estimated to be 1,649 to 1,720 cases per million people. Mean annual hospitalizations among individuals with SCD were 1.39 (95 percent C.I.: 1.3 to 1.4) as compared to 0.10 (95 percent C.I.: 0.09 to 0.1) hospitalizations in persons without SCD. Mean annual hospital days among individuals with SCD were 7.04 (95 percent C.I.: 6.68 to 7.40) as compared to 0.50 (95 percent C.I.: 0.42 to 0.59) hospital days in persons without SCD. Mean annual outpatient visits in individuals with SCD were 24.7 (95 percent C.I.: 23.9 to 25.5) as compared to 14.18 (95 percent C.I.: 13.4 to 14.9) outpatient visits in persons without SCD. Mean annual emergency room visits in individuals with SCD were 3.71 (95 percent C.I.: 3.5 to 3.9) as compared to 0.89 (95 percent C.I.: 0.8 to 0.9) emergency room visits in persons without SCD. Incremental hospitalizations among individuals with SCD were 1.38 (S.E.: 0.05, p<0.001), whereas incremental hospital days among individuals with SCD were 6.94 (S.E.: 0.29, p<0.001). Incremental outpatient visits among individuals with SCD were 7.27 (S.E.: 0.37, p<0.001), and incremental emergency room visits among individuals with SCD were 2.66 (S.E.: 0.08, p<0.001). Among 8,652 persons with SCD, 4,972 had a diagnosis of Sickle Cell Crisis and 3,680 persons with SCD had no diagnosis of Sickle Cell Crisis. Mean annual hospitalizations among individuals with Sickle Cell Crisis were 2.17 (95 percent C.I.: 2.08 to 2.25) as compared to 0.34 (95 percent C.I.: 0.31 to 0.38) hospitalizations in persons without Sickle Cell Crisis. Mean annual hospital days among individuals with Sickle Cell Crisis were 10.98 (95 percent C.I.: 10.41 to 11.54) as compared to 1.72 (95 percent C.I.: 1.47 to 1.98) hospital days in persons without Sickle Cell Crisis. Mean annual outpatient visits among individuals with Sickle Cell Crisis were 26.12 (95 percent C.I.: 25.14 to 27.10) as compared to 22.91 (95 percent C.I.: 21.46 to 24.35) outpatient visits in persons without Sickle Cell Crisis. Mean annual emergency room visits among individuals with Sickle Cell Crisis were 5.28 (95 percent C.I.: 4.97 to 5.60) as compared to 1.58 (95 percent C.I.: 1.45 to 1.72) emergency room visits in persons without Sickle Cell Crisis. In conclusion, SCD was associated with considerable incremental health care resource utilization as compared to individuals without SCD. Additionally, persons with SCD and Sickle Cell Crisis had significant higher healthcare resource utilizations as compared to persons with SCD without Sickle Cell Crisis.

Degree

Ph.D.

Advisors

Thoma, Purdue University.

Subject Area

Pharmacy sciences

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