Sickle Cell Disease (SCD), which afflicts 100,000 Americans, is the most common inherited blood disorder in the US. In 2004, there were about 113,000 hospitalizations for sickle cell related illnesses in the United States, 75% occurring in adults. Estimated annual cost of hospitalization that year was $488 million.
Many large academic health care centers have organized sickle management clinics, a service often not available to community hospitals. We describe the economic impact of sickle cell inpatient management in a large community hospital.
With IRB approval, a retrospective study of the cost of sickle cell crisis readmissions at New Hanover Regional Medical Center in Wilmington, NC was conducted, a 628 bed community hospital in Southeast North Carolina. Individuals identified were patients who had a diagnosis of sickle cell disease and had at least one disease related inpatient admission during a five year study time frame. Data collected pertained to patient demographics, economic impact as well as admission characteristics. Summary statistics were calculated and reported in means, standard deviations, counts and frequencies. The data was analyzed using SAS 9.1.
Within the study time frame, 88 patients, including 433 admissions were analyzed. Only 37 patients (168 admissions) had admissions related to their sickle cell disease. Patients were shown to be 97.3% African American, 56.8% female, 40.5% having Medicaid, and 54.1% with Medicare. Seventeen patients (45.9%) accounted for 131 readmissions (78.0% of total admissions). On average, each admission lasted 5.1 days [SD 3.7] and cost per (patient or per admission) patient was $7,637.95 [SD 5334.26]. In five years, patients spent 863 days in the hospital with a total cost of $1,283,176.83.
As healthcare costs continue to be scrutinized, a more conscious effort will need to be placed on delivering high quality cost-effective care to our sickle cell population. From this analysis, there is a clear economic burden of sickle cell related hospitalizations to community hospitals. It is also clear that there is a small subset of patients who consume a large percentage of the resources. This may lend itself well to focused collaborative care management services of these high consumers of healthcare resources.
The inpatient management of sickle cell vaso-occlusive crisis is well known, but the goal of treatment extends beyond that of just inpatient management. Patients with SCD need effective management in the outpatient setting in hopes to prevent readmissions, reduce hospital length of stays, and ultimately decrease the economic burden to our healthcare system.
Given the significant economic burden to the community hospital, we plan to initiate a focused ambulatory quality improvement project. We plan to track the economic cost of providing intensive outpatient management, balanced against this historical cost information. We will systematically study the ability of a community hospital to impact the natural history of this devastating disease.
No relevant conflicts of interest to declare.
Asterisk with author names denotes non-ASH members.