SCDAA 46th Annual National Convention

Abstract

Authors:
Dr. Menaka Bhor- Novartis, Dr. Lin Xie- SIMR, Inc, Dr. Jincy Paulose- Novartis, Dr. Huseyin Yuce- New York City College of Technology, Dr. Nirmish Shah- Duke University

OBJECTIVE: Vaso-occlusive crisis (VOC) is the hallmark of patients with sickle-cell disease (SCD), and cause patients severe pain, life-threatening complications, hospitalization, decreased quality of life, and early death. This study evaluated the rate of VOC episodes by place of service among adult patients with SCD in the US Medicaid population.
Methods: A retrospective study was conducted using the Medicaid Analytic Extracts Database from 01JAN2009-31DEC2013. Adult patients with SCD were identified using ICD-9-CM diagnosis codes (282.41-282.42, 282.60-282.69). The first observed SCD diagnosis date during the identification period (01JUL2009-31DEC2012) was designated as the index date. Patients were required to have continuous Medicaid health plan enrollment for ≥6 months pre-index date (baseline period) and ≥12 months post-index date (follow-up period). VOC episodes were examined for various follow-up periods, until the earliest occurrence of health plan disenrollment, death, or end of the study period (31DEC2013). Patient demographics and baseline clinical characteristics were examined. VOC claims within a 3-day gap were combined and considered as one VOC episode. The rate of VOC episodes per person-year during the follow-up period was calculated as total number of VOC episodes divided by the total follow-up length to adjust for different patient follow-up periods. VOC episodes in the first month of follow-up was also examined and stratified by setting care, including hospitalization, emergency room (ER), outpatient, office, and other. All variables were analyzed descriptively.
 RESULTS: The study included 8,521 patients; mean (standard deviation [SD]) age was 33 (12) years; 74.0% were identified as black, and 67.3% were female. The most common comorbidities during the baseline period were infectious and parasitic disease (19.7%), asthma (10.9%), and fever (9.3%). Mean (SD) length of follow-up period was 2.7 (1.0) years. The rate of VOC episodes was 3.31 per person-year for the overall adult SCD patient population during the entire follow-up period. During the first month of follow-up, 35.2% of patients had ≥1 VOC episode. Mean (SD) number of pain crisis episodes in the first month was 0.5 (0.8) among the adult SCD patients. Of those, 38% were treated during the hospitalization, 31% in the ER, 20% in the outpatient setting, 8% in a physician office, and 3% were treated in other settings (Figure 1). ConclusionS: Adult SCD patients are burdened with a high rate of VOC episodes, with 35% of the patients having at least one VOC episode in 1 month. In addition, SCD patients utilized a substantial amount of health care resources, with the majority of VOC care (70%) occurring within the hospital and ER