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Economic Burden of Sickle Cell Disease: A Retrospective Study of Pediatric and Adult Individuals With Medicaid

Giovanna Tedesco Barcelos1, Telma Peixoto2, Jose Alvir3

  • 1Pfizer AG, Zürich, Switzerland.

American Journal of Hematology
|December 24, 2025
PubMed

Insights

Medicaid enrollees with sickle cell disease (SCD) face significantly higher healthcare costs and resource use. This highlights an urgent need for better SCD management to reduce the economic burden on patients and payers.

Area of Science:

  • Health Economics
  • Hematology
  • Public Health

Background:

  • Limited data exists on the clinical and financial impact of sickle cell disease (SCD) among US Medicaid enrollees.
  • Sickle cell disease (SCD) is a chronic condition requiring significant healthcare resources.

Purpose of the Study:

  • To assess the real-world healthcare resource utilization (HCRU) and costs associated with SCD in pediatric and adult Medicaid populations.
  • To identify the economic burden of SCD on Medicaid enrollees in the United States.

Main Methods:

  • A retrospective analysis using the IBM MarketScan Medicaid database (July 2016-December 2020).
  • Matched 1:1 cohorts of individuals with SCD and without SCD based on age, gender, and race.
  • Comparison of HCRU and costs during a 12-month follow-up period for pediatric (<18 years) and adult (≥18 years) populations.

Main Results:

  • Pediatric patients with SCD had substantially higher hospitalizations, outpatient visits, prescriptions, and total costs compared to controls.
  • Adult patients with SCD experienced significantly increased hospitalizations, ER visits, outpatient visits, prescriptions, and overall costs.
  • Hospitalizations and pharmacy use drove the largest cost differences in pediatric patients, while hospitalizations and ER visits were key cost drivers for adults.

Conclusions:

  • Medicaid enrollees with SCD, both pediatric and adult, incur significantly higher healthcare resource utilization and costs.
  • There is a clear unmet need for improved management strategies for SCD to mitigate its economic impact on individuals and healthcare systems.
  • Effective SCD management could lead to reduced financial burdens for payers and improved patient outcomes.

Keywords:
Medicaidcostshealthcare resource utilizationoutcomes researchsickle cell disease

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