Hydroxyurea Use in Young Children With Sickle Cell Anemia in New York State.
This study examined hydroxyurea usage in young children with sickle cell anemia within New York State (NYS). The cohort was 273 children with sickle cell anemia born in NYS in 2006-2009 and enrolled essentially continuously in Medicaid for the first 4 years of life.



Medicaid data were used to examine hydroxyurea usage in this group by age at first prescription fill, persistence, region, treatment institution, and year. Log-binomial regression models were used to estimate the likelihood of receiving hydroxyurea treatment. Data from birth through 2014 for all members of the study group were assembled and analyzed in 2015.



About 25% of the cohort had at least one filled hydroxyurea prescription by their fifth birthday, and nearly 40% by the end of the study period. The mean proportion of days covered for the first year of therapy was 56.3%. Adherence was also assessed by calculating medication possession ratios for individual treatment periods. Slightly more than one third of treated children showed 80% coverage by these measures. There was a consistent, but not statistically significant, trend toward younger age at first fill. Significant regional and treatment center differences in initiation of hydroxyurea use, but not in persistence after initiation, were noted among NYS centers.



Subsequent to clinical studies demonstrating safety, current NYS-wide use of hydroxyurea in young children with sickle cell anemia appears to be widespread and increasing. However, practice differences between treatment centers and inadequate adherence may limit the full disease-modifying effects of hydroxyurea.
Office of the Medical Director, Office of Quality and Patient Safety, New York State Department of Health, Albany, New York. Electronic address: david.anders@health.ny.gov.
David G
DG
Anders
School of Public Health, University at Albany, State University of New York, Albany, New York.
Fei
F
Tang
Division of Information and Statistics, Office of Quality and Patient Safety, New York State Department of Health, Albany, New York.
Tatania
T
Ledneva
Newborn Screening Program, Wadsworth Center, New York State Department of Health, Albany, New York.
Michele
M
Caggana
Department of Pediatrics, Columbia University Medical Center, New York, New York.
Nancy S
NS
Green
School of Public Health, University at Albany, State University of New York, Albany, New York; Division of Data Management and Research, Office of Primary Care and Health Systems Management, New York State Department of Health, Albany, New York.
Ying
Y
Wang
Office of the Medical Director, Office of Quality and Patient Safety, New York State Department of Health, Albany, New York.
Lawrence S
LS
Sturman
D000755:Anemia, Sickle Cell / Q000188:drug therapy*; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006918:Hydroxyurea / Q000627:therapeutic use*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008484:Medicaid; D009518:New York; D010342:Patient Acceptance of Health Care; D014481:United States
D006918:Hydroxyurea