Clinical Complications and Healthcare Resource Utilization in Medicaid and Commercially Insured Patients with Sickle Cell Disease Receiving Frequent Red Blood Cell Transfusions

Introduction

Sickle cell disease (SCD) is characterized by sickled hemoglobin that can lead to a variety of acute and chronic complications. Red blood cell transfusions (RBCTs) are utilized in some patients with SCD for managing recurrent vaso-occlusive crises (VOCs), anemia, stroke, multi-organ failure, and other clinical complications associated with SCD. Patients with SCD in the United States (US) are mainly covered by Medicaid and commercial insurance. This study descriptively compares clinical complications and healthcare resource utilization (HCRU) among patients with SCD receiving frequent RBCTs in the US covered by Medicaid and commercial insurance.

Methods

This longitudinal, retrospective analysis used the Merative™ MarketScan® Databases to identify patients with ≥1 inpatient or ≥2 outpatient claims (within 365 days of each other) for SCD between January 1, 2015 and March 1, 2019, who received ≥6 RBCTs during any 12-month period. The index date was the date of the sixth RBCT. Eligible patients with Medicaid or commercial insurance were required to have ≥12 months of continuous enrollment before the index date and ≥12 months of continuous enrollment after and including the index date. Patients were followed from index to end of enrollment, death, or end of the study period (February 29, 2020), whichever came first. Demographics were assessed at index. Clinical complications, treatment utilization, and HCRU were descriptively summarized during follow-up for patients covered by Medicaid and commercial insurance.

Results

A total of 721 and 195 patients with SCD receiving frequent transfusions were identified in the Medicaid and commercial databases, respectively. Mean age of patients covered by Medicaid was lower than for those covered by commercial insurance (Medicaid: 17.5 years [standard deviation [SD]:11.5] vs commercial: 26.3 years [SD:15.9]). About half of patients were female (Medicaid: 50.2%; commercial: 52.8%).

Patients covered by Medicaid had a numerically higher mean rate of VOCs per patient per year (PPPY) during follow-up than those covered by commercial insurance (Medicaid: 4.5 [SD: 8.9] vs commercial: 2.2 [SD:4.5]). Compared to those covered by commercial insurance, patients covered by Medicaid had numerically higher prevalence of clinical complications, including acute infections (70.0% vs 49.2%), cerebrovascular disease (51.2% vs 35.4%), chronic lung disease (46.5% vs 29.7%), and mental health complications (34.3% vs 17.9%).

Patients covered by Medicaid had numerically higher mean (SD) rates of pain medication prescription claims PPPY (Medicaid: 12.8 [19.0] vs commercial: 7.5 [13.4]), including opioids (Medicaid: 9.7 [16.5] vs commercial: 6.0 [11.5])). In addition, patients covered by Medicaid had numerically higher mean rates PPPY of inpatient admissions (2.6 [4.0] vs. 1.3 [1.9]), total days in hospital (14.1 [25.2] vs. 7.2 [14.5]), emergency department visits (4.9 [15.6] vs. 2.8 [6.3]), and outpatient prescriptions (40.4 [35.0] vs. 26.2 [24.2]).

Conclusion:

These results indicate that patients receiving frequent RBCTs continue to experience substantial clinical burden and healthcare resource use, with patients covered by Medicaid experiencing greater burden. Further research is warranted to better elucidate the health disparities in patients with SCD receiving frequent RBCTs.

Udeze:Vertex Pharmaceuticals Incorporated: Current Employment, Current equity holder in publicly-traded company. Jerry:Vertex Pharmaceuticals Incorporated: Other: Funded this work. Evans:Merative: Current Employment. Li:Vertex Pharmaceuticals Incorporated: Current Employment, Current equity holder in publicly-traded company. Jain:Vertex Pharmaceuticals Incorporated: Current Employment, Current equity holder in publicly-traded company. Andemariam:Fulcrum Therapeutics: Other: Data Safety Monitoring Board / Adjudication Committee; Agios: Consultancy, Membership on an entity's Board of Directors or advisory committees; Editas: Other: Data Safety Monitoring Board / Adjudication Committee; American Society of Hematology: Research Funding; Novartis: Research Funding; Afimmune: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Global Blood Therapeutics: Consultancy, Membership on an entity's Board of Directors or advisory committees; Health Resources and Services Administration: Research Funding; Pfizer: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Novo Nordisk: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Hemanext: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Vertex: Consultancy, Membership on an entity's Board of Directors or advisory committees; Roche: Consultancy, Membership on an entity's Board of Directors or advisory committees; Sanofi Genzyme: Consultancy, Membership on an entity's Board of Directors or advisory committees; Connecticut Department of Public Health: Research Funding; bluebird bio: Consultancy, Membership on an entity's Board of Directors or advisory committees; Accordant: Consultancy, Membership on an entity's Board of Directors or advisory committees.