Age-related healthcare services utilization for the management of sickle cell disease among treated Texas Medicaid patients

Objectives To determine if there are age-related differences in sickle cell disease (SCD)-related healthcare utilization and to describe temporal healthcare utilization following an emergency department (ED) visit or hospitalization in treated SCD patient population. Methods Texas Medicaid prescription and medical claims from 1 September 2011 to 31 August 2016 were used. Patients aged 2-63 years with at least one inpatient or outpatient SCD medical claim and receiving one or more SCD-related medications (hydroxyurea, opioid or non-opioid analgesics) were included. The primary outcomes were utilization of SCD-related ED, inpatient and outpatient visits, all-cause prescription medications and type of SCD-related service at index and subsequent healthcare services. Age group was the primary independent variable. Key findings Overall (N = 2339), healthcare service utilization was relatively higher among age groups 2-12, 18-25 and 26-40. Proportions of patients having >= 1 ED and >= 1 inpatient visits, respectively, were significantly higher among age groups 2-12 (33.2%; 23.0%), 18-25 (29.3%; 25.1%) and 26-40 (32.3%; 22.4%) as compared with age group 13-17 (21.3%; 12.9%). The number of outpatient visits was highest among children aged 2-12 (4.5 +/- 7.6, P < 0.0001), while mean number of all-cause medications was the highest for older adults aged 41-63 (22.4 +/- 16.3; P < 0.0001). After an index ED visit (N = 598), outpatient visits were the most prevalent healthcare services. After an index hospitalization (N = 203), a subsequent hospitalization was the most prevalent healthcare service. Conclusions Texas Medicaid SCD patients receiving treatment have a high use of healthcare services, especially among children and young adults who are transitioning from childhood to adulthood. Age-specific interventions should be developed to promote optimal care transitions among young adults.