Sickle cell disease chronic joint pain: Clinical assessment based on maladaptive central nervous system plasticity.

Chronic joint pain (CJP) is among the significant musculoskeletal comorbidities in sickle cell disease (SCD) individuals. However, many healthcare professionals have difficulties in understanding and evaluating it. In addition, most musculoskeletal evaluation procedures do not consider central nervous system (CNS) plasticity associated with CJP, which is frequently maladaptive. This review study highlights the potential mechanisms of CNS maladaptive plasticity related to CJP in SCD and proposes reliable instruments and methods for musculoskeletal assessment adapted to those patients. A review was carried out in the PubMed and SciELO databases, searching for information that could help in the understanding of the mechanisms of CNS maladaptive plasticity related to pain in SCD and that presented assessment instruments/methods that could be used in the clinical setting by healthcare professionals who manage chronic pain in SCD individuals. Some maladaptive CNS plasticity mechanisms seem important in CJP, including the impairment of pain endogenous control systems, central sensitization, motor cortex reorganization, motor control modification, and arthrogenic muscle inhibition. Understanding the link between maladaptive CNS plasticity and CJP mechanisms and its assessment through accurate instruments and methods may help healthcare professionals to increase the quality of treatment offered to SCD patients.

Characteristics of acute care utilization of a Delaware adult sickle cell disease patient population.

Sickle cell disease (SCD) is an inherited blood disorder that is chronic in nature and manifests itself through many facets of the patient's life. Comprehensive specialty centers have the potential to reduce health care costs and improve the quality of care for patients who have chronic medical conditions such as heart failure and SCD. The purpose of this practice inquiry was to analyze de-identified data for acute care episodes involving SCD in order to create a detailed picture of acute care utilization for adult patients in Delaware with SCD from 2007 to 2009. Gaining a better understanding of acute care utilization for adults with SCD may provide evidence to improve access to high-quality health care services for this vulnerable patient population in the state of Delaware.

Long-term persistency and costs associated with the use of iron chelation therapies in the treatment of Sickle cell disease within Medicaid programs.

OBJECTIVE: This retrospective study evaluated iron chelating therapy (ICT) discontinuation and costs in Sickle cell disease (SCD) Medicaid recipients using healthcare claims from 2006-2010. METHODS: Patients with ≥1 SCD diagnosis claim, ≥2 claims for deferoxamine (DFO) or deferosirox (DFX), and continuous enrollment ≥6 months prior to and 18 months following ICT initiation were included. Outcomes included treatment discontinuation, persistence (i.e., refill gaps ≥6 weeks), and total healthcare costs. RESULTS: The average age among 404 SCD patients meeting study inclusion criteria was 18.7 (±11.0) years, with 45.8% being males and 66.7% being Blacks. Switches or combinations from DFO at index occurred in 124 (74.7%) patients compared to 10 (4.2%) with DFX at index. The Cox regression model that assessed long-term medication persistence indicated a 1.30-times higher likelihood of treatment discontinuation with DFO compared to DFX (95% CI: 1.06-1.61). Some 19.7% of patient remained on DFX relative to 4.8% on DFO. Both inpatient and total costs were similar in DFX and DFO treatment groups. Following 1 year of treatment, 37.4% remained on DFX compared to 15.7% on DFO. Meaningful differences in treatment discontinuation between the two treatment groups did not occur until 220+ days during the study period. At 18-months, treatment discontinuation rates were high in both groups; 95% for DFO and 80% for DFX. CONCLUSION: This study of SCD Medicaid patients found more therapeutic switches from DFO to DFX and a higher medication persistency rate with DFX than DFO. The conclusions are limited by the study's retrospective nature, which depends on multivariate statistics to account for patient heterogeneity and risk factors.

Costs to hospitals of acquiring and processing blood in the US: a survey of hospital-based blood banks and transfusion services.

BACKGROUND: little is known about the economics of acquiring and processing the more than 14 million units of red blood cells used annually in the US. OBJECTIVE: to determine the average price paid by hospitals to suppliers for a unit of red blood cells and to identify cost variations by region and facility type and size. A secondary objective was to examine costs for additional blood components as well as costs for blood-related processes performed by hospitals. Qualitative input was sought to identify potential cost drivers. METHODS: a cross-sectional survey was performed of a randomized sample of hospital-based blood bank and transfusion service directors. The survey instrument assessed costs of specific blood components and services as incurred by hospitals. Analysis of variance was performed to test for significant variation in costs for red blood cells by geographic region and division, facility type and bed capacity. RESULTS: a total of 213 surveys were completed. The mean (SD) acquisition cost for one unit of red blood cells purchased from a supplier (n = 204) was $US210.74 ± 37.9 and the mean charge to the patient (n = 167) was $US343.63 ± 135. There was significant statistical variation in acquisition cost by US census region (p < 0.0001) and division (p < 0.0001). Teaching hospitals were more likely to receive volume discounts than other facility types. The mean prices paid per unit for fresh frozen plasma (n = 167) and apheresis platelets (n = 153) were $US60.70 ± 20 and $US533.90 ± 69, respectively. The median cost for mandated screening performed onsite (n = 56) was $US50.00 ± 120 and the median storage and retrieval cost (n = 46) was $US68.00 ± 81 per unit. A total of 28% of respondents reported that costs for acquisition, screening and transfusion had 'increased dramatically' over the past 5 years and 23% reported that blood shortages were a significant problem. CONCLUSIONS: the cost of blood continues to increase and price varies by geography. However, the rate of increase in acquisition costs for red blood cells appears to be slowing. This information should be used by organizations and policy makers to improve financing and utilization management for blood components and services.