(227) Impact of acute pain and fatigue on health care resource utilization and costs in sickle cell disease in the United States

Background: : Pain and fatigue are common symptoms of sickle cell disease (SCD), but the economic burden associated with these symptoms remains unclear.

Objective: : This study evaluated whether acute pain and fatigue in patients with SCD are associated with increased health care resource utilization (HCRU) and costs in the United States.

Methods: : A retrospective, longitudinal cohort study was conducted among patients aged ≥12 years who were diagnosed with SCD between October 1, 2015, and June 21, 2024, using the TriNetX Linked Network claims database and TriNetX Dataworks-USA electronic health record data, excluding those with sickle cell trait. Clinical characteristics and treatments were assessed during a 12-month baseline period. Acute pain was defined as an emergency department (ED) or inpatient encounter with an ICD-10-CM code for generic pain or SCD crisis, where intravenous pain medication was administered, or an opioid prescription was given within 7 days of the respective ED/inpatient encounter. Fatigue was defined as hemoglobin levels ≤10.0 g/dL (a proxy for fatigue) or a diagnosis using ICD-10-CM codes for fatigue. Cases were required to meet both definitions of acute pain and fatigue within a 12-month period. Controls included patients without pain and without fatigue throughout the study period. Incremental annual HCRU and costs (2023 US dollars) to payers were estimated via multivariable regression models, adjusting for SCD genotype, baseline treatments, and clinical and demographic characteristics.

Results: : Overall, 1,075 cases and 451 controls were included. Compared with controls, patients with pain and fatigue were more likely to be female (58% vs 51%; P<.05) and to have received hydroxyurea treatment (40% vs 9%; P<.001) and transfusions (46% vs 9%; P<.001) at baseline. Patients with pain and fatigue experienced significantly more comorbidities, including chronic pulmonary disease (37% vs 15%; P<.001) and hypertension (34% vs 18%; P<.001). The probability of inpatient, outpatient, ED, and pharmacy utilization was much greater among patients with pain and fatigue than controls (all P<.001), leading to an average increase in all-cause cost of $7,689 per patient per year ($30,415 in total costs, a 250% increase compared with controls).

Conclusions: : This study highlights the substantial and previously underrecognized economic burden of acute pain and fatigue among patients with SCD, including increased probability of 12-month HCRU. These findings reinforce the need for treatments that address unmet needs for the management of acute pain and fatigue among patients with SCD.

Sponsorship:: Novo Nordisk Inc.