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TCD Screen to Assess Stroke Risk Underutilized in children with sickle cell
Out-of-pocket spending for TCD screening may play a role as less than half of children in study received this high-value screening.

A new study, featured in The American Journal of Managed Care, suggests many children with sickle cell anemia are not undergoing the nationally recommended transcranial Doppler (TCD) screening to access stroke risk, which should be conducted every two years for children with sickle cell starting at age 2 and continuing to age 16.

Sickle cell anemia is a severe form of sickle cell disease characterized by chronically low oxygen levels that can cause organ damage; It can be fatal. It is often painful and accompanied by other issues such as fatigue, dizziness, and shortness of breath; swelling of the hands and feet; jaundice; infections; delayed growth or puberty; and eye problems. Children who are African American, Mediterranean, or Middle Eastern ethnicity are at higher risk of sickle cell disease.

Researchers explained the critical need for stroke screening as such: “Children with sickle cell anemia are at high risk of stroke; without stroke prevention efforts, 10% will have a stroke before they are 18 years old. These strokes are associated with morbidity and substantial health care spending, both in the short term and in the long term. The impact of pediatric stroke is significant because of the large burden it places on children, families, and society.”

Preventive care can significantly reduce the risk of stroke in children with sickle cell anemia.

TCD screening is considered a non‑invasive and cost-effective neuromonitoring device, which can help predict stroke, and therefore, inform clinical care, help prevent disability from stroke, save lives, and reduce medical expenditures. In children with sickle cell anemia, TCD is considered a high-value service.

This particular study was conducted through an analysis of administrative claims from children who have private health insurance and are enrolled in high-deductible health insurance plans (HDHPs). Typically, HDHPs plans tend to have larger deductibles.

The researchers reported that fewer than half of the children in the group are undergoing the TCD screening to access stroke risk.

Additionally, the median out-of-pocket spending for TCD screening was $65, but exceeded $100 for 44% of TCD screens for children covered by HDHPs. In the sampling of administrative records reviewed, out-of-pocket spending also exceeded $100 for 27% of TCD screens for children not in a HDHP.

More studies are needed to assess the role out-of-pocket costs plays in the lack of regular screening, and particularly if HDHPs play a role, and how cost-sharing might improve screening rates.