Evaluation of treatment patterns, healthcare resource utilization and cost of illness for sickle cell disease in Ghana: a private medical insurance claims database study

Abstract

Background Sickle cell disease (SCD) is a major public health concern in sub-Saharan Africa, accounting for nearly 75% of the global disease burden. The current analysis evaluated patient characteristics, treatment patterns, health‑ care resource utilization (HCRU) and associated costs in patients with SCD based on a Private Medical Insurance Database in Ghana. Methods This retrospective longitudinal cohort study was conducted using an e-claims database from Ghana (01 January 2015 to 31 March 2021). Patients were stratifed 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 con‑ tinuous 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 diferent 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% confdence 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 medi‑ cations 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]). Conclusion In this retrospective private insurance claims database analysis, SCD imposes a signifcant 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.