Vaso-occlusive crises in patients with sickle cell disease: Parents' perspectives and association with disease outcomes

Evaluation of treatment patterns, healthcare resource utilization and cost of illness for sickle cell disease in Ghana: a private medical insurance claims database study

BACKGROUND

Sickle cell disease (SCD) is a major public health concern in sub-Saharan Africa, accounting for nearly 75% of the global disease burden. The current analysis evaluated patient characteristics, treatment patterns, healthcare resource utilization (HCRU) and associated costs in patients with SCD based on a Private Medical Insurance Database in Ghana.

METHODS

This retrospective longitudinal cohort study was conducted using an e-claims database from Ghana (01 January 2015 to 31 March 2021). Patients were stratified by age (0 month to < 2 years, ≥ 2 years to ˂6 years, ≥ 6 years to < 12 years, ≥ 12 years to < 16 years; ≥16 years), vaso-occlusive crisis (VOC) (< 1, ≥ 1 to < 3, and ≥ 3 per year), and continuous enrolment. Study outcomes related to patient characteristics, comorbidities, treatment pattern, HCRU were evaluated for pre- and post-index period (index period was between July 2015 to March 2020). Descriptive analysis was used to analyse different study variables.

RESULTS

The study included 2,863 patients (mean age: 20.1 years; Min age: 0; Max age: 83; females 56.1%). Overall, 52.2% (n = 1,495) of SCD patients were ≥ 16 years and 17.0% (n = 486) were in the ≥ 2 to ˂6-years age group. The majority of patients aged ≥ 16 years (62.5%) in the database did not have reported VOC episodes, 35.9% of patients had 1 to 3 VOCs per year and 1.5% had ≥ 3 VOCs per year during the follow-up period. Consultation-based prevalence of SCD was 0.5% [95% confidence interval (CI): 0-1.3%] - 1.4% [CI: 0.6-2.2%]. Malaria, upper respiratory tract infection (URTI) and sepsis were the common complications of SCD. Analgesics were the most frequently prescribed medications followed by anti-infectives, hematinics, and antimalarials. Hydroxyurea, a routine standard of care for SCD was under-utilized. SCD patients had median cost incurred for consultation/hospital services of $11.3 (Interquartile range [IQR] $6.2 - $27.2). For patients with VOC, maximum median cost was incurred for medications ($10.9 [IQR $5.0-$32.6]). Overall median healthcare cost was highest for individuals with ≥ 3 VOCs per year during the follow-up period ($166.8 [IQR $70.3-$223.5]).

CONCLUSION

In this retrospective private insurance claims database analysis, SCD imposes a significant healthcare burden, especially in patients with VOC. There is a need for reimbursed treatment options that could reduce the long-term burden associated with SCD and VOC.

Testicular Infarction in a Sickle Cell Hemoglobinopathy Patient: A Case Report

Vaso-occlusive phenomena in sickle cell disease lead to ischemia and possible infarction of the affected organ. We report a case of a 20-year-old Saudi male known to have homozygous sickle cell hemoglobinopathy who was admitted to our institution with abdominal pain. One day post admission, the patient developed left testicular pain. Ultrasound showed decreased echogenicity, and Doppler examination showed absent blood flow in the left testicle. Left radical orchidectomy was done, and histopathological assessment revealed ischemic necrosis with sickled red blood cells (RBCs). A few studies have been reported worldwide suggesting that a vaso-occlusive event is the mainstay mechanism in such cases. This is the first case reported in the Eastern Province of Saudi Arabia.

Home Management and Prevention of Vaso-Occlusive Crisis of Sickle Cell Disease Knowledge among Nursing Students

Sickle cell crisis, or vaso-occlusive crisis, is a painful complication of sickle cell disease that occurs in adolescents and adults, which is considered the most common reason these patients seek medical attention in an emergency room. Despite the high prevalence of sickle cell disease in the Jazan region, Saudi Arabia, there hasn't been a study looking at nursing students' knowledge about sickle cell disease and home management and prevention of vaso-occlusive crises associated with sickle cell disease. Most of those focused on the investigation of the public, parents of children with sickle cell disease, school students, and patients with sickle cell disease. Therefore, this study aims to assess the level of knowledge about home management and prevention of vaso-occlusive crises among Saudi nursing students at the Aldayer University College, Jazan University, Kingdom of Saudi Arabia. A descriptive cross-sectional design was used in this study that involved 167 nursing students. The study revealed that Aldayer nursing students had adequate knowledge about the home management and prevention of sickle cell disease vaso-occlusive crises.

Delayed surgical diagnosis and treatment of severe sickle cell arthropathy: The need to raise clinicians' awareness

Objectives

Sickle cell disease (SCD) is associated with femoral head osteonecrosis and is treated with hip arthroplasty 18 weeks after presentation. However, there is inadequate data regarding the timing of surgical management of severe hip arthropathy. This study explores the problem of delayed diagnosis and surgical management of severe SCD hip arthropathy by comparing the clinical outcomes of patients from Nigeria, Canada and Britain.

Methods

This is a prospective clinical audit of the routine care of 30 adult SCD patients who underwent hip arthroplasty for femoral head osteonecrosis. The clinical data are collected from five medical centers in Britain, Canada and Nigeria and compared.

Results

Hip arthroplasty was delayed beyond 18 weeks in 3 of 14 Nigerian patients (21%), 7 of 10 British patients (70%) and all 6 Canadian patients (100%). The majority of Nigerian patients (79%) and only 30% of British patients had diagnostic imaging and surgical management without delay.

Conclusion

Inadequate physician awareness and delayed surgical management of SCD hip arthropathy can be mitigated by improving the education of physicians who manage patients with SCD. It is essential to recruit, train and support physicians with an interest in SCD. As this primarily affects young patients, it is necessary to set an international standard for the timing of surgical management of SCD hip arthropathy.