The highest-cost Medicaid enrollees with sickle cell disease had annual health care expenditures nearing $200 000

Area of Science:

• Hematology
• Health Economics
• Public Health

Background:

• Sickle cell disease (SCD) is a chronic, painful blood disorder with severe complications and comorbidities.
• SCD affects millions globally, with an estimated 100,000 individuals in the U.S., predominantly of Black or Latino descent.
• High healthcare utilization and spending are characteristic of chronic conditions like SCD.

Purpose of the Study:

• To analyze the 2021 healthcare utilization and spending patterns of Medicaid enrollees diagnosed with SCD.
• To identify disparities in healthcare expenditures among Medicaid beneficiaries with SCD.
• To provide data on the economic burden of SCD within the Medicaid population.

Main Methods:

• Utilized Transformed Medicaid Statistical Information System (T-MSIS) data, including enrollment, claims, and encounter information.
• Focused the analysis on the calendar year 2021.
• Examined healthcare expenditures, including medical and pharmacy costs.

Main Results:

• Medicaid enrollees with SCD exhibit high annual medical and pharmacy expenditures.
• Healthcare spending is unevenly distributed across the SCD Medicaid population.
• The top 5% of healthcare spenders, particularly those with genotypes eligible for clinical trials, incurred average annual costs approaching $200,000.

Conclusions:

• Significant financial resources are dedicated to managing sickle cell disease within the Medicaid program.
• Targeted interventions and resource allocation may be necessary for high-cost SCD patient subgroups.
• Further research into cost-effective management strategies for SCD is warranted.