title: Long-term persistency and costs associated with the use of iron chelation therapies in the treatment of Sickle cell disease within Medicaid programs.
abstract: OBJECTIVE
  This retrospective study evaluated iron chelating therapy (ICT) discontinuation and costs in Sickle cell disease (SCD) Medicaid recipients using healthcare claims from 2006-2010.
  
  
  METHODS
  Patients with ≥1 SCD diagnosis claim, ≥2 claims for deferoxamine (DFO) or deferosirox (DFX), and continuous enrollment ≥6 months prior to and 18 months following ICT initiation were included. Outcomes included treatment discontinuation, persistence (i.e., refill gaps ≥6 weeks), and total healthcare costs.
  
  
  RESULTS
  The average age among 404 SCD patients meeting study inclusion criteria was 18.7 (±11.0) years, with 45.8% being males and 66.7% being Blacks. Switches or combinations from DFO at index occurred in 124 (74.7%) patients compared to 10 (4.2%) with DFX at index. The Cox regression model that assessed long-term medication persistence indicated a 1.30-times higher likelihood of treatment discontinuation with DFO compared to DFX (95% CI: 1.06-1.61). Some 19.7% of patient remained on DFX relative to 4.8% on DFO. Both inpatient and total costs were similar in DFX and DFO treatment groups. Following 1 year of treatment, 37.4% remained on DFX compared to 15.7% on DFO. Meaningful differences in treatment discontinuation between the two treatment groups did not occur until 220+ days during the study period. At 18-months, treatment discontinuation rates were high in both groups; 95% for DFO and 80% for DFX.
  
  
  CONCLUSIONS
  This study of SCD Medicaid patients found more therapeutic switches from DFO to DFX and a higher medication persistency rate with DFX than DFO. The conclusions are limited by the study's retrospective nature, which depends on multivariate statistics to account for patient heterogeneity and risk factors.
authors.affiliation: Strategic Therapeutics, Tucson, AZ, USA. ed.armstrong@strategictherapeutics.com
authors.forename: Edward P
authors.initials: EP
authors.lastname: Armstrong
authors.forename: Grant H
authors.initials: GH
authors.lastname: Skrepnek
authors.forename: Medha
authors.initials: M
authors.lastname: Sasane
authors.forename: Susan M
authors.initials: SM
authors.lastname: Snodgrass
authors.forename: Samir K
authors.initials: SK
authors.lastname: Ballas
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000755:Anemia, Sickle Cell / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D001565:Benzoates / Q000191:economics* / Q000627:therapeutic use; D001803:Blood Transfusion; D002648:Child; D000077588:Deferasirox; D003676:Deferoxamine / Q000191:economics* / Q000627:therapeutic use; D004363:Drug Utilization; D005260:Female; D005102:Health Expenditures; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D007502:Iron Chelating Agents / Q000191:economics* / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D057240:Patient Preference / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D044469:Racial Groups / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012737:Sex Factors; D014230:Triazoles / Q000191:economics* / Q000627:therapeutic use; D014481:United States; D016903:Drug Monitoring
chemical_list: D001565:Benzoates; D007502:Iron Chelating Agents; D014230:Triazoles; D003676:Deferoxamine; D000077588:Deferasirox