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. 2023 Feb 14;7(3):365-374.
doi: 10.1182/bloodadvances.2021006281.

Lifetime medical costs attributable to sickle cell disease among nonelderly individuals with commercial insurance

Kate M Johnson  1   2 , Boshen Jiao  1 , Scott D Ramsey  1   3 , M A Bender  4   5 , Beth Devine  1 , Anirban Basu  1   6   7
Affiliations

Lifetime medical costs attributable to sickle cell disease among nonelderly individuals with commercial insurance

Kate M Johnson et al. Blood Adv. .

Abstract

Sickle cell disease (SCD) is a severe monogenic disease associated with high morbidity, mortality, and a disproportionate burden on Black and Hispanic communities. Our objective was to estimate the total healthcare costs and out-of-pocket (OOP) costs attributable to SCD among commercially insured individuals over their nonelderly lifetimes (0 to 64 years of age). We constructed a retrospective cohort of individuals with diagnosed SCD using Truven Health Marketscan commercial claims data from 2007 through 2018, compared with matched control subjects from the Medical Expenditure Panel Survey. We estimated Kaplan-Meier sample average costs using previously reported survival curves for SCD and control subjects. Individuals with SCD (20 891) and control subjects (33 588) were included in our analysis. The SCD sample had a mean age of 25.7 (standard deviation, 17.4) years; 58.0% were female. Survival-adjusted costs of SCD peaked at age 13 to 24 years and declined at older ages. There was no significant difference in total medical costs or OOP costs between the sexes. SCD-attributable costs over 0 to 64 years of age were estimated to be $1.6 million (95% confidence interval [CI], $1.3M-$1.9M) and $1.7 million (95% CI, $1.4M-$2.1M) for females and males with SCD, respectively. The corresponding OOP estimates were $42 395 (95% CI, $34 756-$50 033) for females and $45 091 (95% CI, $36 491-$53 691) for males. These represent a 907% and 285% increase in total medical and OOP costs over control subjects, respectively. Although limited to the commercially insured population, these results indicate that the direct economic burden of SCD is substantial and peaks at younger ages, suggesting the need for curative and new medical therapies.

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Conflict of interest statement

Conflict-of-interest disclosure: The authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Sample selection process.
Figure 2.
Figure 2.
KMSA estimates of total medical costs and OOP costs among individuals with SCD and matched controls by sex, smoothed over age. All estimates are smoothed and survival-adjusted.
Figure 3.
Figure 3.
Total medical costs and OOP costs attributable to SCD and their decomposition into intensity effects and mortality effects. All estimates are smoothed and survival-adjusted.
See this image and copyright information in PMC

References

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