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.
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。