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

Shah, Nirmish; Bhor, Menaka; Latrémouille-Viau, Dominick; Sharma, Vikash; Puckrein, Gary; Gagnon-Sanschagrin, Patrick; Khare, Ankur; Singh, Mukesh Kumar; Serra, Elizabeth; Davidson, M.; Xu, Liou; Guérin, Annie

doi:10.1080/13696998.2020.1813144

Cited by 17 publications

(36 citation statements)

References 29 publications

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“…This will also help us overcome limitations in the sociodemographic data available for enrollees in claims data. Instead, patient attributes will be implicitly represented based on established differences between payer populations [ 57 ].…”

Section: Resultsmentioning

confidence: 99%

Development of a conceptual model for evaluating new non-curative and curative therapies for sickle cell disease

et al. 2022

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Background Sickle cell disease (SCD) is a clinically heterogeneous disease with many acute and chronic complications driven by ongoing vaso-occlusion and hemolysis. It causes a disproportionate burden on Black and Hispanic communities. Our objective was to follow the SMDM/ISPOR Task Force recommendations for good practices and create a conceptual model of the progression of SCD under current clinical practice to inform cost-effectiveness analyses (CEA) of promising curative therapies in the pipeline over a lifetime horizon. Methods We used consultations with experts, providers, and patients to identify acute events and chronic conditions in the conceptual model. We compared our model structure to previous CEA models of interventions for SCD, assessed the prevalence of the identified disease attributes in Medicaid and Medicare claims databases, and identified relevant outcomes following the 2nd Panel in CEA. We determined an appropriate modeling technique and relevant data sources for parameterizing the model. Results The conceptual model structure included four dimensions of disease: chronic pain, acute events, chronic conditions, and treatment complications, spanning 26 disease attributes with significant impacts on health-related quality of life and resource. We modeled chronic pain separately to reflect its importance to patients and interaction with all other disease attributes. We identified additional data sources for health state utilities and non-medical costs and benefits of SCD. We will use a microsimulation model with age- and sex-specific transitions between health states predicted by patient demographic characteristics and disease history. Conclusion Developing the model structure through an explicit process of model conceptualization can increase the transparency and accuracy of results. We will populate the conceptual model with the data sources described and evaluate the cost-effectiveness of curative therapies.

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Section: Resultsmentioning

confidence: 99%

Development of a conceptual model for evaluating new non-curative and curative therapies for sickle cell disease

et al. 2022

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“…There was an equal split in the pattern for reported units of analysis, with per patient (47%) [22-24, 29, 31, 32, 35, 42, 43, 47-49, 54-56, 58-61] and per hospital admission (50%) [25-28, 30, 33, 34, 36-42, 44, 46, 50, 51, 53, 57] as the most frequently reported units. Inpatient costs [22,23,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61] were the most frequently reported cost component, followed by outpatient [23, 24, 31, 32, 35, 39, 42-44, 47, 48, 51, 54, 56, 58-61], pharmacy [22-24, 31, 32, 35, 42, 43, 47, 48, 56, 58-61], and ED costs [22,23,29,31,35,…”

Section: Study Demographicsmentioning

confidence: 99%

“…The annual aggregate economic burden for SCD across all ages in the US was cited as $864 million for inpatient admissions [34], while aggregate costs for SCD individuals under 18 years of age ranged from $164 million to $189 million (Appendix Table B2) [34,36]. Within the general SCD population, total annual costs per patient ranged from $14,012 to $80,842 [31,35,47,48]; inpatient costs were again frequently cited as the highest contributor to overall economic burden (Table 4). Per admission inpatient costs ranged from $5956 to $17,024 [30,33,37,48].…”

Section: General Scd Burdenmentioning

confidence: 99%

Medical and Non-medical Costs of Sickle Cell Disease and Treatments from a US Perspective: A Systematic Review and Landscape Analysis

Baldwin

Jiao

Basu

et al. 2022

PharmacoEconomics Open

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Background Sickle cell disease (SCD) is a complex genetic disorder that manifests in infancy and progresses throughout life in the form of acute and chronic complications. As the upfront costs of potentially curative, genetic therapies will likely be high, an assessment and comprehensive characterization of the medical and non-medical cost burden will inform future decision making. Objective We sought to systematically summarize the existing literature surrounding SCD medical and non-medical costs. Methods We searched MEDLINE and EMBASE (2008-2020) and identified US-based studies that detailed medical or non-medical costs. Eligible studies provided empirical estimates about any aspect of cost or SCD individuals of all ages and their caregivers. Study quality was assessed using the Newcastle-Ottawa Scale, and costs were adjusted to 2019 US$. Results Search queries returned 479 studies, with 342 from medical burden searches and 137 from non-medical burden searches, respectively. Herein, we report the results of the 40 studies that contained relevant cost information: 39 detailed medical costs and 1 detailed non-medical costs. Costs were higher for SCD patients when compared with non-SCD individuals

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“…Although there are some data regarding the costs associated with SCD in Europe and the United States, [ 8 , 9 ] such data are not yet available for LMICs. The aim of this study was to evaluate the costs associated with acute complications of SCD at a large publicly-funded hematology center in Brazil, over a 6-month period.…”

Section: Introductionmentioning

confidence: 99%

Cost analysis of acute care resource utilization among individuals with sickle cell disease in a middle-income country

Lobo

Moura

Fidlarczyk

et al. 2022

BMC Health Serv Res

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Background The costs associated with the treatment of sickle cell disease (SCD) are understudied in low and middle-income countries (LMIC). We evaluated the cost of treating SCD-related acute complications and the potential cost-savings of hydroxyurea in a specialized hematology center in Brazil. Methods The costs (US dollars) of emergency department (ED) and hospitalizations from SCD-related complications between 01.01.2018 and 06.30.2018 were ascertained using absorption and micro-costing approaches. The reasons for acute hospital visits were grouped as: 1) vaso-occlusive (VOC) pain, 2) infection, 3) anemia exacerbation, and 4) chronic organ damage complications. Hydroxyurea adherence was estimated by medication possession ratio (MPR) during the study period. Results In total, 1144 patients, median age 17 years (range 0–70), 903 (78.9%) with HbSS/HbSβ0-thalassemia, 441 (38.5%) prescribed hydroxyurea, visited the ED, of whom 381 (33%) were admitted. VOC accounted for 64% of all ED visits and 60% of all admissions. Anemia exacerbation was the most expensive reason for ED visit ($321.87/visit), while chronic organ damage carried the highest admission cost ($2176.40/visit). Compared with other genotypes, individuals with HbSS/HbSβ0-thalassemia were admitted more often (79% versus 21%, p < 0.0001), and their admission costs were higher ($1677.18 versus $1224.47/visit, p = 0.0001). Antibiotics and analgesics accounted for 43% and 42% of the total ED costs, respectively, while housing accounted for 46% of the total admission costs. Costs of ED visits not resulting in admissions were lower among HbSS/HbSβ0-thalassemia individuals with hydroxyurea MPR ≥65% compared with visits by patients with MPR <65% ($98.16/visit versus $182.46/visit, p = 0.0007). No difference in admission costs were observed relative to hydroxyurea use. Discussion In a LMIC hematology-specialized center, VOCs accounted for most acute visits from patients with SCD, but costs were highest due to anemia exacerbation. Analgesics, antibiotics, and housing drove most expenses. Hydroxyurea may reduce ED costs among individuals with HbSS/HbSβ0-thalassemia but is dependent on adherence level.

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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 commerciallyinsured, Medicaid-insured, and Medicare-insured patients with sickle cell disease (SCD).

Cited by 17 publications

References 29 publications

Development of a conceptual model for evaluating new non-curative and curative therapies for sickle cell disease

Development of a conceptual model for evaluating new non-curative and curative therapies for sickle cell disease

Medical and Non-medical Costs of Sickle Cell Disease and Treatments from a US Perspective: A Systematic Review and Landscape Analysis

Cost analysis of acute care resource utilization among individuals with sickle cell disease in a middle-income country

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