Access to Sickle Cell Disease Care Often Varies by Insurance Status
Patients with sickle cell disease (SCD) who are insured through Medicaid used hematology care services at a far lower rate than commercially insured patients, according to research presented at the 59th American Society of Hematology (ASH) Annual Meeting & Exposition (December 9-12, 2017; Atlanta, GA).
Medicaid patients also exhibited greater emergency department (ED) use and lower compliance with hydroxyurea (HU) treatment.
SCD is a chronic hematologic condition associated with increased risk for vaso-occlusive crises, acute chest syndrome, and significant end-organ damage. Guidelines recommend routine HU and blood transfusions to reduce mortality and disease-related adverse events.
SCD care requires a multidisciplinary approach, and prior research has shown that as patients transition from pediatric to adult care, they often face challenges related to provider access. Carlton Dampier, MD, Emory University School of Medicine (Atlanta, GA), and colleagues identified pediatric and adult patients with SCD to determine the relationship between insurance type and care receipt.
The study included cohorts of commercially insured patients (mean age, 27 years; 50% female) and patients insured through Medicaid (mean age, 18 years; 50% female). Across all age groups, a lower proportion of Medicaid-insured patients (2%-15%) had access to specialized hematology care than commercially insured patients (39%-47%). However, the proportion of commercially insured adult patients who received specialized care was significantly lower than commercially insured pediatric patients
Medicaid patients experienced more ED visits and inpatient admissions than commercially insured patients. In both payer cohorts, adult patients were more likely to visit the ED or receive an inpatient admission.
HU use was low among both payer cohorts. The lowest rates of continuous HU use (greater than 90 days) were seen among patients aged 18 years to 30 years.
“The higher ED and inpatient use and lower HU compliance in the Medicaid population may be indicative of greater severity and/or unmet need,” researchers concluded. “These data highlight the importance of ongoing initiatives such as the ASH SCD Coalition to increase access to care in the United States.”—Cameron Kelsall