Economic Burden of Sickle Cell Disease: A Retrospective Study of Pediatric and Adult Individuals With Medicaid Coverage From 2016 to 2020

There is limited information regarding the contemporary real-world clinical and financial burden of Medicaid enrollees with sickle cell disease (SCD) in the United States. Using the IBM MarketScan Medicaid database (7/2016-12/2020), individuals with ≥ 3 SCD diagnoses were matched 1:1 on age, gender, and race to individuals without SCD. Continuous coverage was required during 6-month baseline and 12-month follow-up periods. Follow-up healthcare resource utilization (HCRU) and costs were compared between the SCD and non-SCD cohorts in separate analyses of the pediatric (< 18 years, n = 4723 per cohort, 52% male, mean age: 8.8 years) and adult (≥ 18 years, n = 5597 per cohort, 60% female, mean age: 35.1 years) populations. During follow-up, pediatric individuals with SCD had significantly more hospitalizations (0.8 vs. 0.03) with longer length of stay (LOS, 3.0 vs. 0.1 days), outpatient visits (19.5 vs. 10.8), prescriptions (12.8 vs. 3.8), and higher mean total costs ($18 900 vs. $2127) than individuals without SCD; hospitalizations (39.6-fold) and pharmacy use (11.9-fold) accounted for the largest cost differences. Adults with SCD had significantly more hospitalizations (2.1 vs. 0.1; LOS: 11.3 vs. 0.7 days), outpatient visits (46.5 vs. 22.5), office visits (7.7 vs. 4.9), prescriptions (29.5 vs. 13.7), and higher mean total costs ($45 114 vs. $6039) than adults without SCD; hospitalizations (18.7-fold) and ER visits (12.7-fold) had the greatest cost differences. In conclusion, pediatric and adult Medicaid enrollees with SCD had significantly higher HCRU and costs, demonstrating an unmet need for improved management of SCD to potentially reduce the economic burden for both payers and individuals with SCD.