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Blood, 1 October 2000, Vol. 96, No. 7, pp. 2369-2372
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Financial analysis of chronic transfusion for stroke
prevention in sickle cell disease
Alan S. Wayne,
Steve E. Schoenike, and
Charles
H. Pegelow
From the Department of Pediatrics, Division of
Pediatric Hematology Oncology, Sickle Cell Center, and Pediatric
Pharmacy Department, University of Miami School of Medicine, Jackson
Memorial Medical Center, Miami, FL.
Chronic red blood cell transfusion can prevent many of the
manifestations of sickle cell disease. The medical costs of chronic transfusion and management of associated side effects, especially iron
overload, are considerable. This study was undertaken to evaluate the
financial impact of chronic transfusion for stroke prevention in
patients with sickle cell anemia. Outpatient charges pertaining to
hospital-based Medicare uniform bill (UB-92) codes, professional fees,
and iron chelation were evaluated. Data were collected on 21 patients
for a total of 296 patient months (mean, 14; median, 14 months/patient). Charges ranged from $9828 to $50 852 per patient per
year. UB-92, chelation, and physician-related charges accounted for
53%, 42%, and 5% of total charges, respectively. Of UB-92 charges,
58% were associated with laboratory fees and 16% were related to the
processing and administration of blood. Charges for patients who
required chelation therapy ranged from $31 143 to $50 852 per patient
per year (mean, $39 779; median, $38 607). Deferoxamine accounted for
71% of chelation-related charges, which ranged from $12 719 to
$24 845 per patient per year (mean, $20 514; median, $21 381). The
financial impact of chronic transfusion therapy for sickle cell disease
is substantial with charges approaching $400 000 per patient decade
for patients who require deferoxamine chelation. These data should be
considered in reference to cost and efficacy analyses of alternative
therapies for sickle cell disease, such as allogeneic bone marrow transplantation.
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