Costs, charges, and reimbursements for persons with sickle cell disease

Purpose: The aims of this study were to describe health care costs and char ges for patients with sickle cell disease (SCD) and identify predictors of high use. Patients and Methods: Patients with SCD were identified by International Cl assification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) co des from a university hospital's administrative databases from January 1, 1 996, to September 30, 1997. Clinical and administrative data were gathered on each patient for all hospital admissions and ambulatory clinic visits. L ogistic regression models were used to determine predictors of high health care use. Results: A total of 947 patients with SCD were identified, 73% of whom resi ded within three South Carolina counties. On average, there were 0.9 admiss ions per patient per year and 8.0 outpatient visits per patient per year. M ean inpatient hospital charges, physician charges, and direct hospital cost s per admission were $7290, $1589, and $5405, respectively, and the average length of stay was 4.5 days. Mean hospital charges, physician charges, and direct hospital costs per outpatient visit were $305, $169, and $688, resp ectively. Forty percent of the inpatient hospital charges were accounted fo r by only 4.2% of the patients. Residing in a distant county and being admi tted with a diagnosis of painful respiration were found to be predictors of excessive charges and expenses beyond expected reimbursements. Conclusions: Patients with SCD are frequent users of health care services. Charges and costs are distributed disproportionately across these patients. Predictors of excessive hospital charges include living geographically dis tant from the hospital and being admitted with a diagnosis of painful respi ration.