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Abstract：
BACKGROUND: Sickle cell disease (SCD) is a major public health concern in sub-Saharan Africa, accounting for nearly 75% of the global disease burden. The current analysis evaluated patient characteristics, treatment patterns, healthcare resource utilization (HCRU) and associated costs in patients with SCD based on a Private Medical Insurance Database in Ghana.
METHODS: This retrospective longitudinal cohort study was conducted using an e-claims database from Ghana (01 January 2015 to 31 March 2021). Patients were stratified by age (0 month to < 2 years, ≥ 2 years to ˂6 years, ≥ 6 years to < 12 years, ≥ 12 years to < 16 years; ≥16 years), vaso-occlusive crisis (VOC) (< 1, ≥ 1 to < 3, and ≥ 3 per year), and continuous enrolment. Study outcomes related to patient characteristics, comorbidities, treatment pattern, HCRU were evaluated for pre- and post-index period (index period was between July 2015 to March 2020). Descriptive analysis was used to analyse different study variables.
RESULTS: The study included 2,863 patients (mean age: 20.1 years; Min age: 0; Max age: 83; females 56.1%). Overall, 52.2% (n = 1,495) of SCD patients were ≥ 16 years and 17.0% (n = 486) were in the ≥ 2 to ˂6-years age group. The majority of patients aged ≥ 16 years (62.5%) in the database did not have reported VOC episodes, 35.9% of patients had 1 to 3 VOCs per year and 1.5% had ≥ 3 VOCs per year during the follow-up period. Consultation-based prevalence of SCD was 0.5% [95% confidence interval (CI): 0-1.3%] - 1.4% [CI: 0.6-2.2%]. Malaria, upper respiratory tract infection (URTI) and sepsis were the common complications of SCD. Analgesics were the most frequently prescribed medications followed by anti-infectives, hematinics, and antimalarials. Hydroxyurea, a routine standard of care for SCD was under-utilized. SCD patients had median cost incurred for consultation/hospital services of $11.3 (Interquartile range [IQR] $6.2 - $27.2). For patients with VOC, maximum median cost was incurred for medications ($10.9 [IQR $5.0-$32.6]). Overall median healthcare cost was highest for individuals with ≥ 3 VOCs per year during the follow-up period ($166.8 [IQR $70.3-$223.5]).
CONCLUSIONS: In this retrospective private insurance claims database analysis, SCD imposes a significant healthcare burden, especially in patients with VOC. There is a need for reimbursed treatment options that could reduce the long-term burden associated with SCD and VOC.
METHODS: This retrospective longitudinal cohort study was conducted using an e-claims database from Ghana (01 January 2015 to 31 March 2021). Patients were stratified by age (0 month to < 2 years, ≥ 2 years to ˂6 years, ≥ 6 years to < 12 years, ≥ 12 years to < 16 years; ≥16 years), vaso-occlusive crisis (VOC) (< 1, ≥ 1 to < 3, and ≥ 3 per year), and continuous enrolment. Study outcomes related to patient characteristics, comorbidities, treatment pattern, HCRU were evaluated for pre- and post-index period (index period was between July 2015 to March 2020). Descriptive analysis was used to analyse different study variables.
RESULTS: The study included 2,863 patients (mean age: 20.1 years; Min age: 0; Max age: 83; females 56.1%). Overall, 52.2% (n = 1,495) of SCD patients were ≥ 16 years and 17.0% (n = 486) were in the ≥ 2 to ˂6-years age group. The majority of patients aged ≥ 16 years (62.5%) in the database did not have reported VOC episodes, 35.9% of patients had 1 to 3 VOCs per year and 1.5% had ≥ 3 VOCs per year during the follow-up period. Consultation-based prevalence of SCD was 0.5% [95% confidence interval (CI): 0-1.3%] - 1.4% [CI: 0.6-2.2%]. Malaria, upper respiratory tract infection (URTI) and sepsis were the common complications of SCD. Analgesics were the most frequently prescribed medications followed by anti-infectives, hematinics, and antimalarials. Hydroxyurea, a routine standard of care for SCD was under-utilized. SCD patients had median cost incurred for consultation/hospital services of $11.3 (Interquartile range [IQR] $6.2 - $27.2). For patients with VOC, maximum median cost was incurred for medications ($10.9 [IQR $5.0-$32.6]). Overall median healthcare cost was highest for individuals with ≥ 3 VOCs per year during the follow-up period ($166.8 [IQR $70.3-$223.5]).
CONCLUSIONS: In this retrospective private insurance claims database analysis, SCD imposes a significant healthcare burden, especially in patients with VOC. There is a need for reimbursed treatment options that could reduce the long-term burden associated with SCD and VOC.
摘要：
背景：镰状细胞病（SCD）是撒哈拉以南非洲的主要公共卫生问题，占全球疾病负担的近75%。当前的分析评估了患者的特征，治疗模式,基于加纳私人医疗保险数据库的SCD患者的医疗资源利用(HCRU)和相关费用。
方法：本回顾性纵向队列研究使用加纳的电子索赔数据库（2015年1月1日至2021年3月31日）进行。患者按年龄分层(0个月至<2岁，≥2年至≥6年，≥6年至<12年，≥12年至<16年；≥16年)，血管闭塞性危象（VOC）（每年<1，≥1至<3和≥3），和持续入学。研究结果与患者特征相关，合并症,治疗模式,HCRU进行了评估前和后指数期（指数期为2015年7月至2020年3月）。描述性分析用于分析不同的研究变量。
结果：该研究包括2,863例患者（平均年龄：20.1岁；最小年龄：0；最大年龄：83；女性56.1％）。总的来说,52.2％（n=1,495）的SCD患者≥16岁，17.0％（n=486）的患者≥2至6岁。数据库中大多数年龄≥16岁的患者（62.5%）没有报告VOC发作，在随访期间，35.9%的患者每年有1~3个VOCs，1.5%的患者每年有≥3个VOCs。基于咨询的SCD患病率为0.5％[95％置信区间（CI）：0-1.3％]-1.4％[CI：0.6-2.2％]。疟疾,上呼吸道感染（URTI）和脓毒症是SCD的常见并发症。镇痛药是最常用的处方药，其次是抗感染药，充血,和抗疟药。羟基脲,SCD的常规治疗标准未得到充分利用.SCD患者的咨询/医院服务费用中位数为11.3美元（四分位距[IQR]$6.2-$27.2）。对于VOC患者，药物费用中位数最高(10.9美元[IQR$5.0-$32.6]).在随访期间，每年VOCs≥3的个体的总体医疗费用中位数最高(166.8美元[IQR70.3-223.5美元])。
结论：在此回顾性私人保险索赔数据库分析中，SCD带来了巨大的医疗保健负担，尤其是VOC患者。需要可以减少与SCD和VOC相关的长期负担的报销治疗方案。
方法：本回顾性纵向队列研究使用加纳的电子索赔数据库（2015年1月1日至2021年3月31日）进行。患者按年龄分层(0个月至<2岁，≥2年至≥6年，≥6年至<12年，≥12年至<16年；≥16年)，血管闭塞性危象（VOC）（每年<1，≥1至<3和≥3），和持续入学。研究结果与患者特征相关，合并症,治疗模式,HCRU进行了评估前和后指数期（指数期为2015年7月至2020年3月）。描述性分析用于分析不同的研究变量。
结果：该研究包括2,863例患者（平均年龄：20.1岁；最小年龄：0；最大年龄：83；女性56.1％）。总的来说,52.2％（n=1,495）的SCD患者≥16岁，17.0％（n=486）的患者≥2至6岁。数据库中大多数年龄≥16岁的患者（62.5%）没有报告VOC发作，在随访期间，35.9%的患者每年有1~3个VOCs，1.5%的患者每年有≥3个VOCs。基于咨询的SCD患病率为0.5％[95％置信区间（CI）：0-1.3％]-1.4％[CI：0.6-2.2％]。疟疾,上呼吸道感染（URTI）和脓毒症是SCD的常见并发症。镇痛药是最常用的处方药，其次是抗感染药，充血,和抗疟药。羟基脲,SCD的常规治疗标准未得到充分利用.SCD患者的咨询/医院服务费用中位数为11.3美元（四分位距[IQR]$6.2-$27.2）。对于VOC患者，药物费用中位数最高(10.9美元[IQR$5.0-$32.6]).在随访期间，每年VOCs≥3的个体的总体医疗费用中位数最高(166.8美元[IQR70.3-223.5美元])。
结论：在此回顾性私人保险索赔数据库分析中，SCD带来了巨大的医疗保健负担，尤其是VOC患者。需要可以减少与SCD和VOC相关的长期负担的报销治疗方案。
