Healthcare utilization patterns, associated factors, and readmission rates among children with sickle cell disease.

Sickle Cell Disease (SCD) is common in Saudi Arabia, with a prevalence rate of 2.3%. It is an expensive disease to manage due to the extensive utilization of healthcare resources, including hospital readmissions, extended hospital stays, and frequent emergency department visits, which cost approximately $395 million annually in U.S. dollars. The primary objective of this study was to conduct a systematic literature review of healthcare utilization and cost of patients with SCD, following the PICO framework and PRISMA guidelines. The second aim utilized count models, including the negative binomial and Poisson, to identify factors associated with emergency, inpatient, and outpatient hospital visits among children with SCD. The third aim employed a multi-episode survival analysis to assess the association between bone marrow transplantation and the risk of emergency and inpatient readmission rates among children. The Andersen-Aday and Donabedian conceptual models informed the statistical variables for aims two and three, respectively. De-identified data provided by the King Abdullah International Medical Research Center (KAIMRC) were used in this study. Factors affecting the average annual number of inpatient visits were the total number of complications (incidence rate ratio, IRR = 1.23), crisis episodes (IRR = 1.03), and living in the Eastern (IRR = 2.65) and Western and Southern (IRR = 1.98) regions of Saudi Arabia. Similarly, for emergency visits, the total number of complications (IRR = 1.52), total crisis episodes (IRR = 1.04), bone marrow treatment (IRR = 0.33), hydroxyurea (IRR = 1.72), and living in the Eastern Saudi Arabia region (IRR = 3.41) were examined. For an outpatient visit, the Charlson Comorbidity Index (CCI) score (IRR = 1.33), bone marrow treatment (IRR = 1.81), age (IRR = 1.02), and living in the Eastern Saudi Arabia region (IRR = 0.65) were significant factors. The association between bone marrow treatment and the risk of emergency readmission was estimated and compared to those who did not receive bone marrow treatment. Health policies regarding bone marrow treatment receipt and preventive healthcare can help alleviate the burden of healthcare costs. Keywords: Sickle Cell Disease, Healthcare Utilization, Pediatric Patients, Readmission Rates, Saudi Arabia,