Clinical pathway implementation for adult sickle cell vaso-occlusive crises: Impact on healthcare utilization, opioid prescribing, and costs

BACKGROUND: Vaso-occlusive crisis (VOC) is the leading cause of emergency department (ED) visits and hospitalization in sickle cell disease (SCD). Standardized clinical pathways may improve care quality and reduce healthcare utilization, yet regional evidence from Saudi Arabia remains limited. OBJECTIVES: To evaluate the clinical and economic impact of a multidisciplinary clinical pathway on VOC management, opioid prescribing, and direct healthcare costs. DESIGN: Retrospective before-and-after cohort study. SETTING: Single-center, 500-bed tertiary referral hospital in Jeddah, Saudi Arabia. PATIENTS AND METHODS: Adults (≥12 years) with confirmed SCD (HbSS, HbSC, or HbS/β-thalassemia) presenting with isolated VOC were included. Outcomes were compared across two consecutive 12-month periods before (May 2016-April 2017) and after (May 2017-April 2018) pathway implementation. MAIN OUTCOME MEASURES: Annual ED visits, hospital admissions, 7-day readmission rate, opioid consumption, length of stay, and direct cost savings. SAMPLE SIZE: 316 unique patients pre-implementation and 374 post-implementation. RESULTS: <.001); the readmission rate fell from 29.1% to 13.2%. Median length of stay decreased from 11.0 to 4.3 days. Meperidine and tramadol utilization declined significantly, whereas morphine use increased by 41.2%. When standardized to oral morphine milligram equivalents, total opioid burden nonetheless decreased by 21.8% overall (33.9% per patient-year). Annual direct cost savings totaled 410 709 Saudi Riyals. CONCLUSIONS: Implementation of a multidisciplinary VOC clinical pathway was associated with substantial reductions in healthcare utilization, hospital stay, readmissions, and direct costs, while promoting evidence-based opioid prescribing in adults with SCD. LIMITATIONS: Single-center, uncontrolled before-and-after design without adjustment for genotype imbalance between cohorts; incomplete pathway adherence in some clinical areas; patient-reported outcomes were not collected.