Analgesic Utilization Pattern and Cost of Managing Children with Sickle Cell Diseases: a Retrospective Single-site Audit.

BACKGROUND INFORMATION: Sickle cell disease (SCD), a β-haemoglobinopathy, is a neglected multi-system disorder caused by inherited abnormal haemoglobin structure or production and leads to catastrophic economic burden on affected households and societies. We assessed the predictors of both SCD severity and SCD care costs.

METHODS

This is a retrospective chart review of eligible children with SCD in a developing setting. Their sociodemographic, clinical and costs data were collected and analyzed using SPSS version 26.0 with p ≤ 0.05 considered significant.

RESULTS

Overall 2503 children with SCD (female: 1053 [51.3%]; median (interquartile range) age: 4.00 (5.75) years and range age: 0.08-14.00 years) participated in the study with their median (interquartile range) age at first pain crisis, age at first hospitalization, costs of outpatient, inpatient and total patient care; analgesics and laboratory investigations being 1.00 (1.25) years, 1.00 (1.13) years, 89.8 (110.6) USD, 47.9 (63.4) USD and 200.4 (158.8) USD; 3.8 (3.5) USD and 28.6 (16.9) USD respectively. The major predictors of SCD severity were [hospitalization frequency: use of parenteral non-opioids (odds ratio (OR): 8.65; 95% CI:3.84-19.46; p < 0.001) and having a history of parental consanguinity (OR: 6.28; 95% CI:1.59-24.86; p = 0.009); hospitalization duration: having a history of parental consanguinity (OR: 3.73; 95% CI:2.03-6.83; p < 0.001) and type of oral analgesics (OR: 3.28; 95% CI:2.57-4.17; p < 0.001)]. The major predictors of the following cost variables were: analgesics [total amount of non-opioids (OR: 2.34; 95% CI:2.10-2.60; p < 0.001) and total number of oral opioids (OR: 4.56; 95% CI:3.60-5.78; p < 0.001)]; laboratory investigation [total amount of oral opioids (OR: 1.41; 95% CI:1.27-1.56; p = 0.0005)]; outpatient care [school attendance (OR: 20.64; 95% CI:10.47-40.69; p < 0.001), comorbidity (OR: 2.68; 95% CI:1.52-4.75; p < 0.001) and pentazocine (OR: 1.32; 95% CI:1.12-1.56; p < 0.001)]; inpatient care [having a history of parental consanguinity (OR: 10.67; 95% CI:4.81-23.67; p < 0.001)] and total patient care [pentazocine (OR: 14.75; 95% CI:10.17-35.68; p < 0.001)].

CONCLUSION

Consanguinity and analgesics use were the major predictors of both SCD severity and SCD care costs.