Improvement of Sickle Cell Disease Care Mitigates the Healthcare Utilization Induced by Increased Prevalence: Experience of a Tertiary Pediatric Center
Maude Cigna, Alexia Muresan, Estelle Lecluze, Karine Leduc, Nathalie Fournier, Maria Tamer, Jean‐François Delisle, Jeremi Charbonneau, Annie Viau, Jessica Darilus, Marie‐Joëlle Doré‐Bergeron, Valérie Arsenault, Evelyne Doyon‐Trottier, Stéphanie Forte, Nancy Robitaille, Yves Pastore, Thomas PincezABSTRACT
Background
Sickle cell disease (SCD) has undergone major changes in the last decades. Its prevalence has been steadily increasing and numerous advances have been made in the management of the disease. However, the effect in real‐life setting of these major changes is unknown, particularly in a Canadian environment.
Procedure
We aimed to assess the impact of these changes on the evolution in the healthcare utilization (HCU) of children with SCD in a Canadian pediatric tertiary center from 2009 to 2024.
Results
The number of children with SCD followed at our center more than doubled (221 to 499 patients). Practice changes reduced mean time to hydroxyurea introduction, resulting in a steady annual increase in mean fetal hemoglobin across the patients with HbSS. Reflecting the number of patients followed, the absolute number of annual outpatient and ED visits increased significantly (1207 to 1769 and 192 to 526, respectively). However, there was a significant decrease in the mean number of outpatient visits (5.46 to 3.55 [ p = 0.03]) and hospitalizations (1.18 to 0.58 [ p <0.0001]) by patient annually. There was also a reduction in the percentage of admissions after an ED visit (62.5% to 42.6% [ p <0.0001]).
Conclusion
Although the number of patients with SCD followed at our institution drastically increased in 15 years, the practice changes were effective and likely mitigated the impact on admissions. It illustrates the significant impact of improved management in the care of patients with SCD. Allocated resources need to reflect the overall increase in HCU to allow for continuous optimal care of this vulnerable population.