OBJECTIVES: To estimate the direct all-cause healthcare costs associated with multimorbidity amongst patients with SCD in England, and the cost per complication.

METHODS: Using Clinical Practice Research Datalink (CPRD) Aurum linked with Hospital Episode Statistics (HES) data, we identified 7,265 patients with SCD aged ≥12 years between 01/04/2007-31/03/2019. Primary and secondary care healthcare resource use were identified from CPRD and HES, respectively; unit costs were obtained from the Unit Costs for Health and Social Care 2018/19 and the National Cost Grouper 2018/19, respectively. All costs were inflated to 2020/21 using the NHS cost inflation index. Cost of multimorbidity (≥2 complications) was estimated using the generalized linear model (gamma family, identity link) with total number of complications during follow up as a categorical variable (0, 1, ≥2). Modelling was repeated with total complications as a continuous variable. Models were adjusted for baseline age, gender, deprivation quintile, ethnicity, and follow up (FU) time centered on the population median of 9.75 years.

RESULTS: Of the 7112 complete cases, 642 patients (9.03%) had multimorbidity. The estimated cost amongst patients with multimorbidity (≥2) was £179,011 (95%CI £157,673-£200,350) per person (PP), with 1 complication was £54,765 (95%CI £48,608-£60,922) PP, and for those with no complications was £14,966 (95%CI £13,325-£16,607) PP over 9.75 years. Separately, the estimated cost per complication was £49,572 (95%CI £45,608-£53,536) PP over 9.75 years.

CONCLUSIONS: Costs for patients with SCD and multimorbidity are significantly higher than for patients with SCD and no complications. Quantification of the cost associated with multimorbidity in patients with SCD in England is important to improve understanding of the healthcare burden of SCD and aid healthcare decision makers when considering treatments which may reduce morbidity.