title: Examining the effectiveness of hydroxyurea in people with sickle cell disease.
abstract: This study investigated hydroxyurea use in people with sickle cell disease (SCD) outside of a research setting. Pharmacy data, outpatient visits, hospital admissions, and length of stay were assessed for all patients with SCD enrolled in a Medicaid managed care organization in Maryland. Three hundred and ninety (390) people with SCD were covered between the years 2001-2005. A large majority (85.9%) never had a claim for a hydroxyurea refill. Hydroxyurea users had higher admission rates than non-hydroxyurea users (5 vs. 1.5, p=.004). Patients who were in the highest tertile of refills of hydroxyurea had significantly fewer hospital admissions than patients in the lowest tertile (2.44 vs. 7.57, p=.043). Patients with the lowest hydroxyurea refill usage had significantly higher mean costs per month enrolled than those with the highest number ($4,553 vs. $2,017, p=.031). Hydroxyurea was underutilized in this patient population. Patients with more regular refills of hydroxyurea had fewer admissions to the hospital and markedly decreased costs.
authors.affiliation: Div. of Hematology, Dept. of Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Suite 7300, Baltimore, MD 21205, USA. slanzkr@jhmi.edu
authors.forename: Sophie
authors.initials: S
authors.lastname: Lanzkron
authors.forename: Carlton
authors.initials: C
authors.lastname: Haywood
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Fagan
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Rand
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data; D000755:Anemia, Sickle Cell / Q000188:drug therapy*; D000986:Antisickling Agents / Q000627:therapeutic use*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006918:Hydroxyurea / Q000627:therapeutic use*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008329:Managed Care Programs / Q000191:economics; D008396:Maryland; D008484:Medicaid / Q000191:economics; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult
chemical_list: D000986:Antisickling Agents; D006918:Hydroxyurea