Sickle cell disease healthcare costs high in U.S.

NEW YORK (Reuters Health) - A new study shows that the annual cost of medical care in the US for people who suffer from sickle cell disease exceeds $1.1 billion.

Sickle cell disease is an inherited blood disorder in which red blood cells contain an abnormal type of hemoglobin and frequently take on a sickle- or crescent-shape. These defective red blood cells can block small blood vessels, which can lead to tissue damage or even stroke. Other complications are anemia, jaundice, gallstones, severe leg and arm pain, and spleen, liver and kidney damage.

Dr. Teresa L. Kauf at the University of Florida in Gainesville and colleagues analyzed data from the Florida Medicaid program on 4,294 sickle cell patients.

They report that the average total cost of care per month per patient was $1,946, with substantial variation across age groups.

Total costs per patient-month were highest in adults, peaking at $2,853 per patient-month for patients aged 30 to 39, and lowest in children from birth through age 9, at $892 per patient-month.

On an annualized basis, the total cost of care ranged from $10,704 for children aged 0 to 9 years to $34,266 for the age 30 to 39 group.

"For an average patient with sickle cell disease reaching age 45, total undiscounted health care costs were estimated to reach $953,640," the researchers report in the American Journal of Hematology.

By their calculations, the estimated cost of medical care for the roughly 70,000 individuals with sickle cell disease in the US "exceeds $1.1 billion."

"When one considers the additional contributions of sickle cell disease associated with reduced quality of life, uncompensated care, lost productivity, and premature mortality, the full burden of sickle cell disease is likely to be quite higher than the figures reported here," Kauf and colleagues note.

Roughly 80% of the costs were associated with inpatient care; 3.2% of costs were associated with emergency department (ED) use, 0.9% with physician visits, and 3.6% with prescription drugs. The remaining 11.7% of costs was from "other care," including home health and nursing home care.

The researchers point out that while ED use did not account for large proportion of costs, ED-related costs increased after age 19, "consistent with (but not confirmatory to) an increase in pain crises among older patients."

Also, they note, "The high proportion of sickle cell disease costs associated with inpatient hospitalizations suggests that interventions that reduce complications such as pain crises could be cost-effective, even cost-saving."

SOURCE: American Journal of Hematology, June 2009.