Healthcare utilization and expenditures for low income children with sickle cell disease.
BACKGROUND
While multiple studies have examined the healthcare burden of sickle cell disease (SCD) in adults, few have specifically focused on healthcare utilization and expenditures in children. The objective of this study was to characterize the healthcare utilization and costs associated with the care of low-income children with SCD in comparison to other children of similar socioeconomic status.


METHODS
For the study period, 2004-2007, we conducted a retrospective, cross-sectional descriptive analysis of administrative claims data from a managed care plan exclusively serving low-income children with Medicaid and the State Children's Health Insurance Plan (SCHIP). Patient demographics, continuity of insurance coverage, healthcare utilization, and expenditures were collected for all children enrolled with SCD and the general population within the health plan for comparison.


RESULTS
On average, 27% of members with SCD required inpatient hospitalization and 39% utilized emergency care in a given calendar year. Both values were significantly higher than those of the general health plan population (P < 0.0001). Across the study period, 63% of members with SCD averaged one well child check per year and 10% had a minimum of one outpatient visit per year to a hematologist for comprehensive specialty care.


CONCLUSIONS
Low-income children with SCD demonstrate significantly higher healthcare utilization for inpatient care, emergency center care, and home health care compared to children with similar socio-demographic characteristics. A substantial proportion of children with SCD may fail to meet minimum guidelines for outpatient primary and hematology comprehensive care.
Department of Pediatrics, Baylor College of Medicine, Academic General Pediatrics, Houston, Texas, USA. raphael@bcm.edu
Jean L
JL
Raphael
Craig L
CL
Dietrich
Deborah
D
Whitmire
Donald H
DH
Mahoney
Brigitta U
BU
Mueller
Angelo P
AP
Giardino
D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000191:economics*; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data*; D004632:Emergency Medical Services; D005102:Health Expenditures; D006760:Hospitalization; D006801:Humans; D007297:Inpatients; D012189:Retrospective Studies; D012923:Social Class