Comparative effectiveness of emergency department versus pain infusion clinic management for acute pain in adults with sickle cell disease: Implications for cost and timeliness of care

Abstract Background: Acute pain is the most common reason for healthcare utilization among adults living with Sickle Cell Disease (SCD). While Emergency Departments (EDs) remain the default care setting for many SCD patients in pain, ED use is often associated with prolonged wait times, high likelihood of admission, and high costs along with significant patient distress and delayed effective treatment. In contrast, dedicated SCD pain infusion clinics offer a potentially more efficient, familiar, and patient-centered approach. Prior studies, including those by Lanzkron et al. (2015, 2021), have demonstrated the superiority of pain infusion clinics versus EDs for acute pain management in SCD. We sought to replicate this evidence by studying pain infusion clinic visits vs ED visits for SCD pain in another large academic medical center, focusing especially on healthcare charges and time to first analgesic administration. Methods: We conducted a retrospective analysis of 548 adult SCD patients who presented for acute pain in 2024. The sample was broken down in 3 categories: patients that visited the ED only (N=189), dual users -patients that visited both the ED and the pain infusion clinic (N=172), and patients that pain infusion clinic only (N=187). Wilcoxon rank-sum tests compared total healthcare charges and time to first pain medication between ED visits and pain infusion clinic visits. Admission rates were calculated for both settings. A counterfactual analysis estimated potential cost savings if ED visits were hypothetically managed in the pain infusion clinic instead. Although the center participates in the PCORI-funded “Implementing the Infusion Clinic Model in Sickle Cell Disease” (NCT02411396) project, this dataset and the analyses conducted were independent of that initiative. Results: ED visits were significantly more expensive (Z = -33.43; p < .0001) and associated with longer time to first analgesia (Z = -12.38; p < .0001) than pain infusion clinic visits. Admission rates were 35.3% for all ED users and 39.6% among ED visits by dual users, compared to 0% for pain infusion clinic visits. Counterfactual modeling projected cost savings of approximately $25 million if dual users had exclusively used the pain infusion clinic and an additional $13.7 million if ED-only users had done the same. Conclusion: Pain management delivered through a dedicated Pain Clinic is significantly more cost-effective and timelier than ED-based care for adults with SCD. Admission rates were eliminated in the pain infusion clinic setting, suggesting substantial clinical and economic benefits. These findings reinforce the urgent need to expand access to outpatient infusion models and reduce dependency on the ED for acute pain crises in this high-utilization population. Kanter J, Smith WR, Desai PC, Treadwell M, Andemariam B, Little J, Nugent D, Claster S, Manwani DG, Baker J, Strouse JJ, Osunkwo I, Stewart RW, King A, Shook LM, Roberts JD, Lanzkron S. Building access to care in adult sickle cell disease: defining models of care, essential components, and economic aspects. Blood Adv. 2020 Aug 25;4(16):3804-3813. doi: 10.1182/bloodadvances.2020001743. PMID: 32785684; PMCID: PMC7448595. Lanzkron S, Carroll CP, Hill P, David M, Paul N, Haywood C Jr. Impact of a dedicated infusion clinic for acute management of adults with sickle cell pain crisis. Am J Hematol. 2015 May;90(5):376-80. doi: 10.1002/ajh.23961. Epub 2015 Feb 25. PMID: 25639822; PMCID: PMC4409504. Lanzkron S, Little J, Wang H, Field JJ, Shows JR, Haywood C Jr, Saheed M, Proudford M, Robertson D, Kincaid A, Burgess L, Green C, Seufert R, Brooks J, Piehet A, Griffin B, Arnold N, Frymark S, Wallace M, Abu Al Hamayel N, Huang CY, Segal JB, Varadhan R. Treatment of Acute Pain in Adults With Sickle Cell Disease in an Infusion Center Versus the Emergency Department : A Multicenter Prospective Cohort Study. Ann Intern Med. 2021 Sep;174(9):1207-1213. doi: 10.7326/M20-7171. Epub 2021 Jul 6. Erratum in: Ann Intern Med. 2021 Sep;174(9):1347. doi: 10.7326/L21-0522. PMID: 34224261.