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Acute care utilization in pediatric sickle cell disease and sickle cell trait in the USA: prevalence, temporal trends, and cost

Abstract

The objective of this study was to analyze acute care utilization of sickle cell disease (SCD) and sickle cell trait (SCT) in children and identify trends in emergency department (ED) visits and inpatient admissions over a 10-year period. This is a retrospective population-based study of SCD- and SCT-related ED visits and admissions from 2006 to 2015. Data were acquired from the Healthcare Cost and Utilization Project (HCUP), National Inpatient Sample (NIS), and National Emergency Department Sample (NEDS) database. Cost-to-charge and estimated professional fee ratios were applied to approximate costs. Over 80% of medical expenditure on HbSS is through ED-based admissions. There is a statistically significant increase from 2006 to 2015 in the direct hospital admissions associated with patients less than 18 years of age who have been diagnosed with SCT.

Conclusion: Among patients less than 18 years of age with HbSS, inpatient admissions through the emergency department accounted for the largest medical expenditure of the SCD subtypes.

What is Known:
• There are currently no multi-year, nationwide analyses of acute care utilization in sickle cell disease and sickle cell trait (SCT) in the pediatric population.
• SCT is more common than SCD, affecting 1.5% of all infants born in the USA.
What is New:
• Comprehensive annual costs of acute care utilization of patients less than 18 years of age with SCD and SCT in the USA which includes aggregated demographical patient care data and to illustrate temporal trends of acute care utilization in children less than 18 years of age with SCD and SCT
• Among patients less than 18 years of age with HbSS, inpatient admissions through the emergency department accounted for the largest medical expenditure of the sickle cell disease subtypes.

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Abbreviations

APC:

Annual percent change

CCR:

Cost-to-charge ratio

CI:

Confidence interval

DRG:

Diagnosis-related group

ED:

Emergency department

HbSS:

Homozygous sickle cell disease

HCUP:

Healthcare Cost and Utilization Project

ICD-9-CM:

International Classification of Diseases, Ninth Edition, Clinical Modification

KID:

Kids’ Inpatient Database

NEDS:

National Emergency Department Sample

NIS:

National Inpatient Sample

PFR:

Professional fee ratio

SCD:

Sickle cell disease

SCT:

Sickle cell trait

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Funding

This study was supported by the Health Resources and Services Administration (HRSA) (Grant No. 1 D3HP31024-01-00) for the project titled Baylor College of Medicine (BCM) Center of Excellence in Health Equity, Training & Research.

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Authors

Contributions

EEP conceptualized the project and assisted in drafting the manuscript. JLS performed the data analyses and assisted in drafting the manuscript. DD performed the data analyses and assisted in drafting the manuscript. HMS managed the project and reviewed the manuscript for accuracy

Corresponding author

Correspondence to Deepa Dongarwar.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was deemed exempt by the IRB of Baylor College of Medicine as the study was performed on secondary de-identified data.

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Communicated by Peter de Winter

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Peterson, E.E., Salemi, J.L., Dongarwar, D. et al. Acute care utilization in pediatric sickle cell disease and sickle cell trait in the USA: prevalence, temporal trends, and cost. Eur J Pediatr 179, 1701–1710 (2020). https://doi.org/10.1007/s00431-020-03656-x

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Keywords

  • Sickle cell disease
  • Sickle cell trait
  • Costs
  • Hospitalization
  • HCUP
  • Inpatient
  • Emergency department