title: Outcomes, utilization, and costs among thalassemia and sickle cell disease patients receiving deferoxamine therapy in the United States.
abstract: Deferoxamine mesylate (DFO) reduces morbidity and mortality associated with transfusional iron overload. Data on the utilization and costs of care among U.S. patients receiving DFO in typical clinical practice are limited however. This was a retrospective study using a large U.S. health insurance claims database spanning 1/97-12/04 and representing 40 million members in >70 health plans. Study subjects (n = 145 total, 106 sickle cell disease [SCD], 39 thalassemia) included members with a diagnosis of thalassemia or SCD, one or more transfusions (whole blood or red blood cells), and one or more claims for DFO. Mean transfusion episodes were 12 per year. Estimated mean DFO use was 307 g/year. Central venous access devices were required by 20% of patients. Cardiac disease was observed in 16% of patients. Mean total medical costs were $59,233 per year including $10,899 for DFO and $8,722 for administration of chelation therapy. In multivariate analyses, potential complications of iron overload were associated with significantly higher medical care costs. In typical clinical practice, use of DFO in patients with thalassemia and SCD receiving transfusions is low. Administration costs represent a large proportion of the cost of chelation therapy. Potential complications of iron overload are associated with increased costs.
authors.affiliation: Policy Analysis Inc. (PAI), Brookline, MA 02445, USA. tdelea@pai2.com
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Delea
authors.forename: May
authors.initials: M
authors.lastname: Hagiwara
authors.forename: Simu K
authors.initials: SK
authors.lastname: Thomas
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Baladi
authors.forename: Pradyumna D
authors.initials: PD
authors.lastname: Phatak
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Coates
mesh_terms: D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D009202:Cardiomyopathies / Q000453:epidemiology / Q000209:etiology; D015913:Chelation Therapy / Q000191:economics / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual / Q000706:statistics & numerical data; D003676:Deferoxamine / Q000627:therapeutic use*; D016527:Drug Costs; D005260:Female; D006801:Humans; D007223:Infant; D007501:Iron / Q000009:adverse effects; D007502:Iron Chelating Agents / Q000627:therapeutic use*; D019190:Iron Overload / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013789:Thalassemia / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D065227:Transfusion Reaction; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D007502:Iron Chelating Agents; D007501:Iron; D003676:Deferoxamine